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THE AMERICAN AmDEMY OE POLITICAL 
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SOCIAL WORK WITH FAMILIES 

SOCIAL CASE TREATMENT 

tKfje Annate 

Volume LXXVII with supplement ■ Mat, 19ia 

Editok: CLYDE L. KING 

Assistant Editok: E. M.PATTERSON 

Associate Editor: JOSEPH H. WILLITTS 

Editok Book Dept.: C. H. CEENNAN 

Editorial ConKca: THOMAS CONWAY, Jr., A. R. HATTON, AMOS S. HERSHEY, 

E. M. HOPKINS, S. S. HUEBNER, CARt KELSEY, J. P. LITCHENBERGER, 

ROSWELL C. MoCREA, L. S. ROWE, HENRY SUZZALLO, 

T. W. VAN METRE. F. D. WATSON. 

Editor in Charge of this Volume: 

FRANK D. WATSON, Ph.D. 

Associate Professor of Social Work, 

Haverford College 




The American Academy of Political and Social Science 

36th and Woodland Avenue 

Philadelphia 

1918 



Copjright, 1918, by 

The Amebican Academy of Political and Social Science 

All rights reserved 



EUROPEAN AGENTS 

England: P. S. King & Son, Ltd., 2 Great Smith Street, Westminister, London, S. W. 
FsaNCE: L. Laroae, Rue Soufflot, 22, Paris. 

Gbbuant: Mayer & MUUer, 2 Prinz Louis Ferdinandstrasse, Berlin, N. W. 
Italy: Giornale Degli Economisti, via Monte Savello, Palaazo Orsini, Rome. 
' Spain: E. Dossat, 9 Plaza de Santa Ana, Madrid. 



CONTENTS 

Page 

FOREWORD vii 

Prank D. Watson, AsBOciate Professor of Social Work, Haverford 
College. 

PART I— THE APPROACH TO SOCIAL CASE TREATMENT 

THE OPPORTUNITIES OF SOCIAL CASE TREATMENT 1 

Karl deSchweinitz, General Secretary, Philadelphia Society for Organiz- 
iag Charity. 

CASE WORK AND SOCIAL REFORM 9 

Mary Van Kleeck, Director of the Women's Division, Industrial Serv- 
ice Section, Ordnance Department. 



THE NORMAL FAMILY. >ir. 13 

Margaret F. Byington, Associate Secretary, American Association for 
Organizing Charity. 

PART II— SOCIAL CASE WORK WITH THE PHYSICALLY OR 
MENTALLY HANDICAPPED 

OFFSETTING THE HANDICAP OF BLINDNESS 28 

Lucy Wright, Associate Director, Boston School of Social Work. • 

THE CRIPPLE AND HIS PLACE IN THE COMMUNITY 36 

Amy M. Hamburger, Formerly Assistant and Associate Director, Cleve- 
land Cripple Survey. 

THE- SICK 45 

Edna G. Henry, Director, The Social Service Department of Indiana 
University. 

PRINCIPLES OF CASE WORK WITH THE FEEBLE-MINDED. . . 60 
Catherine Brannick, M.D., Psychologist, Massachusetts Reformatory 
for Women. y- 

r 

CASE WORK IN/THE FIELD OF MENTAI+, HYGIEN? 71 

Elndra E. Thomson, Executive Secretary, Illinois Society for Mental 
Hygiene. 

PART III— SOCIAL CASE WORK WITH THE SOCIALLY 
HANDICAPPED 

THE FATHERLESS FAMILY 79 

Helen Glenn Tyson, State Supervisor, Mother's Assistance Fimd of 
Pennsylvania. 

iii 



iv Contents 

DESERTION AND NON-SUPPORT IN FAMILY CASE WORK. . . 91 
Joanna C. Colcord, Superintendent, New York Charity Organization 
Society. 

THE ILLEGITIMATE FAMILY 103 

Amey Eaton Watson, Chairman, Philadelphia Conference on Parent- 
hood. 

THE FOSTER CARE OF NEGLECTED AND DEPENDENT CHIL- 
DREN 117 

J. Prentice Murphy, General Secretary, Boston Children's Aid Society. 

ESSENTIALS OF CASE TREATMENT WITH DELINQUENT CHIL- 
DREN 131 

Henry W. Thurston, Member of Staff, The New York School of Phil- 
anthropy. 

THE HOMELESS 140 

Stuart A. Rice, Formerly Superintendent, New York Municipal Lodging 
House. 

ALCOHOL AND SOCIAL CASE WORK 154 

Mary P. Wheder, Secretary, Clinton District, New York Charity Or- 
ganization Society. 

THE IMMIGRANT FAMILY 160 

Eva W. White, Director, the Extended Use of the Public Schools, 
Boston. 

THE SOLDIERS' AND SAILORS' FAMILIES 171 

W. Frank Persons, Director General of Civilian Relief, the Americaii 
Red Cross. 

BOOK DEPARTMENT 185 

INDEX 195 



Contents 



BOOK DEPARTMENT 

THE BUSINESS MAN'S LIBEARY 

Bailbt and Ctjmmings — Statistics (R. Riegel) 186 

Kemmerek — Postal Savings (F. Parker) 185 

LBPFiNGWELli — Scientific Office Management (M. Keir). 185 

Secrist — An Introduction to Statistical Methods (R. Riegel) 186 

WiCEWABB (Ed.) — The American Year Book, 1917 188 

ECONOMICS 

Bullock — Selected Articles on Single Tax (C L. King) 188 

HoBSON — Democracy after the War (E. M. Patterson) 188 

Kellogg and Taylor — The Food Problem (H. R.,M. Landis) 189 

Nicholson — War Finance (E. M. Patterson) 190 

Phelps — Selected Articles on the Income Tax (C. L. King) 188 

political science 

Freund — Standards of American Legislation (F. G. Bates) 190 

KETTLEBOROUGH-^T^e State Constitutions (C. H. Crennan) 191 

Robinson and West — The Foreign Policy of Woodrow Wilson, 1913-1917 

(L. P. Fox) , 191 

sociology 

Calhoun — A Social History of the American Family from Colonial Times to 

the Present, Vols. I and II (J. P. Lichtenberger) 193 

Carter — The Control of the Drink Trade (E. G. Lowe) 194 

Steinbk — The Japanese Invasion (C. Kelsey) 194 



FOREWORD 

The development of the principles and methods of social case 
work has been a slow and almost unconscious evolution. Only re- 
cently have social case workers become articulate in the technique 
of their field. They have been such "deadly doers" that little time 
has been left to analyze critically the technique of the day's work. 
Miss Richmond's book, "Social Diagnosis," is monumental not 
only because of its scope and scholarship but because it marks the 
beginning of that painstaking analysis of the methods and principles 
of social case work which must obtain generally before social case 
workers can call their chosen field a profession. Miss Richmond's 
book deals exclusively with social diagnosis, treatment being 
omitted except in the sense that all diagnosis is a part of treatment. 
A volume on Social Case Treatment is therefore opportune, espe- 
cially in view of the urgent need at this time of an authoritative 
statement of the best thought and practice in the field of treatment, 
because of the many social problems incident to the war. While 
the war may have created no new type of social problems, it has 
increased them many fold and has given some entirely new settings. 
The inevitable dislocation of industrial life with its migrations of 
workers, the disruption of family life in many homes following the 
departure of the father or son for war service, the readjustment to 
industrial life of the soldier returning from the front, possibly 
crippled, or handicapped by bUndness, all make a knowledge of the 
principles and methods of -social case treatment of paramount 
importance. 

It is hoped that the present volume in addition to being of 
interest to the general reader will prove not only a reference book 
to which social case workers generally may turn for new light on 
some of their oldest problems but that it will also serve as a store- 
house of knowledge based on tested experience for all Home Service 
workers and all those other workers, professional and volunteer, 
who have been drafted in the ranks of social case workers because of 
the unprecedented demand for this type of work incident to the war. 
It should never be lost sight of in this connection that the problems 
of "civilian relief" differ in no essentials from the problems which 
social case workers throughout the country have been meeting in their 



Viii FOBEWOBD 

day's work before the war and that the methods of helping to solve 
them differ in no essential details from the methods followed in the 
past by the best of our case-working agencies. Human nature 
does not change over night nor during a war. The big problems of 
a widow's family are the same, whether the husband has lost his life 
in the military or industrial army. The readjustment of a man to 
industrial life is much the same, be he crippled by a bursting shell 
or by a bursting fly wheel in the factory. Questions of care for 
orphaned children are much the same be the cause of their orphan- 
hood sickness and anxiety incident to war or death following occu- 
pational disease. 

While certain articles like that by Miss Hamburger on "The 
Cripple and His Place in the Community," that by Miss Wright on 
"Off-Setting the Handicap of Blindness" and that by the Director- 
General of Civilian Relief on "Soldiers' and Sailors' Families" may 
seem to have more direct bearing on the problems of the Home Serv- 
ice worker, it is felt that all the articles throw light on problems with 
which Home Service workers will sooner or later have to deal. In 
fact the principles and methods of social case work are imiversal in 
their apphcation. Not only is the corner-stone of all case work, — 
individualization of treatment, — revolutionizing the science of 
penology, but it is profoundly modifying our educational practice. 
Small classes, more frequent promotions, special classes for the 
backward and for the handicapped as well as the movement for 
industrial education, all reflect the growing recognition among edu- 
cators of the principle of individualization. Even in our home life, 
we must use this principle if we are to understand the developing 
life of our own children. Come what may in the future evolution 
of our social life, this principle will stand as vital, and the time and 
thought and patience that are put into this delicate work will re- 
ceive more and more recognition as the parent, the teacher and the 
social worker can show the results that come from its application. 

A volume on social case treatment covers but a section, though 
an important one, of the whole field of social work. The unity of 
social work is such that the effectiveness of any piogram of social 
workers is materially affected by the quality of work done in any 
part of the field. All good social case work has a double value. It 
not only makes possible work with a given individual or family, help- 
ing them to solve their own problems, but with its first hand know!- 



Foreword ix 

edge of social and industrial conditions and of the action and re- 
action of environment and heredity, it affords a valuable fund of 
information for scientific research and thus lays the foundation for 
effective propaganda looking toward the creation of an intelligent 
public opinion which is important for all wise legislation and essen- 
tial for all effective law enforcement. Social case work when well 
done is therefore not only constructive but preventive as well, both 
for the individual and for society. 

The articles in this volume have been divided into three groups : 
those which afford an approach to social case treatment; those 
articles which discuss social case work with the physically or men- 
tally handicapped; and those articles which deal with social case 
work with the socially handicapped. The last article in the first 
group, "The Normal Family," affords a perspective for all workers 
with family problems and so adds materially to the value and unity 
of the volume. While there is no fundamental difference in the 
technique of social case work as found in the various articles, they 
do , exhibit some adaptations in case work technique that are of 
significance. 

Certain points of view characterize all or almost all the articles. 
The many references to the war show what a big place this cataclysm 
is occupying in the thoughts of all the writers. Almost all the 
articles breathe an impatience with the point of view that a social 
case worker's job is done when the individual or family in question 
has been helped. There is a sense of humility pervading the articles, 
though each is written by one chosen for his or her wide experience 
in social case work in his or her particular field. The thought con- 
stantly recurs that workers in each field are still breaking new 
ground. All the articles reflect a great truth which is constantly 
borne in on all social case workers but often missed by those who 
believe that any one panacea can remedy all our social evils. This 
truth is that the causes of our various social problems are exceed- 
ingly numerous, varied and complex, subtile of analysis and diffi- 
cult of appraisement and that the solutions of these problems are as 
many and varied as the causes themselves. This may prove dis- 
quieting to some. It nevertheless remains true that there are few 
if any short-cuts in the field of the social sciences and that a sympa- 
thetic understanding of the complexity of our social life is the first 
step in all real progress. 

Frank D. Watson. 



THE OPPORTUNITIES OF SOCIAL CASE TREATMENT 

By Karl deSchweinitz, 
G eneral Secretary, Philadelphia Society for Organizing Charity. 

The door of the examining room opened and two young men 
came into the recruiting office, each with a slip of paper in his hand. 
They looked about uncertainly for a moment; then catching sight 
of an "information" sign, walked over to the desk which was thus 
labeled. The soldier who sat behind it glanced at the memorandum 
that the first man handed him. 

"You've a double hernia," he announced. 

"Same with you," he added, turning to the second volunteer. 

"You can't enter the army unless you have it fixed," he con- 
tinued, addressing both of the young fellows who apparently desired 
further information. 

"Here, I'll give you the name of a hospital where you can 
have an operation for nothing. If you weren't going into the army 
it would cost you $120." 

He scribbled the address upon the back of the memorandum. 

"Even if I wasn't going into the army I'd have the operation. 
I wouldn't go around with a thing like that for anything. Why 
you're liable to wake up some morning and find yourself dead." 

The soldier paused, but not long enough for a reply. 

"There's nothing to the operation. I've assisted at hundreds 
of them in the military hospital. It doesn't amount to much more 
than taking an anesthetic. I've seen men up and about in eight 
days. It won't cost you a cent and if you want to get into the army 
it's the thing to do." 

The first young man looked at the second. "Come on," he said 
and picked up the slip with the address of the hospital upon it. 
Together the two volunteers left the office. 

Admit that the soldier urged a course of action without hav- 
ing any fundamental knowledge of the needs of those whom he 
advised. Admit that his method of doing this was crude. He 
nevertheless was following a procedure that should be most sug- 
gestive for those who are interested in the development of social 
case treatment. 

2 1 



2 The Annals of the American Academy 

The men came to him in a predicament. That is precisely 
what brings people to the case worker, whether the predicament be 
called trouble, distress, a situation or misfortune; whether it be a 
prison record, truancy, poverty or sickness; whether the case worker 
be a representative of the court, the children's society, the society 
for organizing charity, or the hospital social service department. 

What the soldier did and what the case worker must do are 
basicly the same. The soldier, first of all, told the men just what 
their predicament involved ; — they could not enter the army because 
they were suffering from hernia. Second, he pointed a way out of 
the difficulty — the hospital. Third, he suggested various motives 
which might help the men to take that way. He appealed to their 
sense of economy, or rather to that fundamental desire to get some- 
thing for nothing which seems to be part of everybody — "If you 
weren't going into the army it (the operation) would cost you $120." 
He aroused their sense of fear on the one hand — ^they might wake 
some morning and find themselves dead — ^and he allayed it on the 
other — ^the operation "doesn't amount to much more than taking 
an anesthetic." Study of almost any record of successful case treat- 
ment will show a procedure similar in its rudiments to that which 
the soldier observed. 

Consider, for example, the predicament of the family of Herbert 
Jones. They were without food. Nearly all of their furniture had 
been sold. Mrs. Jones and one of the children were sick. Mr. 
Jones was out of work. He had been arrogant toward his fellow 
workmen, so arrogant that the union to which he had belonged was 
unwilling to help him. He was drinking heavily. He abused his 
wife and had been brought at least once before the Domestic Rela- 
tions Court. The case worker discovered that Mr. Jones was an 
extremely sensitive man who craved friendship and affection. As 
often happens with such men his arrogance was the unfortunate 
result of fear of injury to his feelings and of his unconscious efforts to 
protect himself. He had taken to drink because he thought that in 
that way he could become a good fellow among the men of the 
neighborhood. He abused his wife partly because of remorse for his 
intemperance and partly because he was jealous of what he thought 
was her too great devotion to two children whom she had had by a 
former marriage. 

The first step in treatment was to show the man and the woman 



Opportunities of Social Case Treatment 3 

what was involved in their predicament. The case worker inter- 
preted the husband to the wife, helping her to see that the man's 
abuse and his jealousy were really caused by his affection for her. 
Next came the suggestion that, were the source of irritation to be 
removed, the family life could become happy once more. The way 
out lay in an arrangement to have the stepchildren live with their 
grandparents, and the woman's desire for a happy association with 
her husband provided the motive for doing this. 

With the man, treatment involved a frank facing of the facts of 
his situation. His baseless jealousy and the unpleasant effect which 
his arrogance had upon those who knew him were made plain to him. 
His predicament was himself. The remedy lay in a struggle against 
himself. The social worker offered him assistance in this struggle. 
His home would be reestablished. His wife would be helped back 
to health. The union officials would be placated so that he could 
once more obtain work. The motive suggested to the man was the 
possibility of achieving the kind of family life and companionship 
among his fellows for which he longed. Accompanying this was 
the encouragement and the sense of assurance afforded by the in- 
terest of the case worker in his welfare. 

The method of treatment here was precisely the method of the 
soldier in deaUng with the two volunteers. First, the case worker 
showed the family what was involved in their predicament, second, 
she pointed to the way out, third, she supplied a motive. 

Often the steps in this method follow each other so closely as 
to render analysis almost impossible. Thus the realization of the 
predicament may furnish the motive. Again, the man or the woman 
may have decided upon the remedy but may need motivation; or 
realizing their predicament they may need both a way out and a 
motive to inspire them to take that way. 

A teamster who liked horses too much to want to learn how to 
operate a motor-truck, found himself reduced to such odd jobs of 
driving as he could find. Gradually he became accustomed to irreg- 
ular work until unemployment became a habit. He realized what 
was wrong but knew no remedy, and even if he had known one he 
lacked initiative enough to lift himself out of his predicament. The 
solution lay in a job on a stock breeding farm and the motive which 
led him to take this solution was the adventure of going to a new and 
a rural environment. 



4 The Annals of the Amebican Academy 

Although it may not always be necessary to show a man either 
directly or by implication the elements of his predicament it is essen- 
tial, of course, for the case worker to understand them. This means 
investigation, and after investigation diagnosis. The method of 
investigation is well defined. The importance of the first inter- 
view, the value of seeing relatives, former employers, and the other 
factors in this phase of case work are admitted. Social workers, 
however, must do more than follow these steps. They must take 
them without for a moment forgetting that the end of investigation 
is diagnosis and that diagnosis is the beginning of treatment. Treat- 
ment depends for its success upon an investigation conducted with 
this in mind. 

Diagnosis, moreover, is made primarily, it should be remem- 
bered, for the benefit of the person xmder treatment, not for the in- 
formation of the case worker. Here, again, inspiration and sugges- 
tion can be obtained from study of the methods of the medical pro- 
fession. The tendency among physicians, evidenced by the in- 
creasing stress which is being laid upon personal hygiene, is to make 
the patient understand his trouble in order that he may adjust his 
life so as to overcome his disease — of com-se, with the help of what 
therapeutic or surgical assistance may be necessary. This also 
must be the method of social case treatment. 

The way out or the ways out which are opened to the family or 
the individual after they have been shown the impUcations of their 
predicament are really opportunities to develop the kind of personal 
equipment and environment that will enable them to reestablish 
themselves. The job in the country was not the solution for the 
teamster who had acquired the habit of unemployment. It was 
merely the offering of a new environment in which he could reach 
the solution. The solution itself lay in the development of character, 
of the habit of industry, of a greater measure of initiative. The re- 
moval of the stepchildren to their grandparents and the obtaining 
of a job for the man who had been abusing his wife was not the solu- 
tion. He had had many different jobs before and conceivably the 
stepchildren might have left his home without producing the desired 
result. The ultimate solution lay in his victory over himself. The 
job and the change in domestic arrangements served merely to pro- 
vide him a more favorable environment. 

The elements involved in securing such an environment and in 



Opportunities of Social Case Theatment 5 

making possible the development of a better personal equipment are 
as well defined as are the processes of investigation. They are 
health, education, mental hygiene, home economics, work, play, 
spiritual influence. These things are the means which the case 
worker uses in administering social treatment. They must not be 
considered as ends in themselves but only as influences in helping 
the family and the individual to readjust their lives. 

Case work agencies which in their annual reports list the num- 
ber of people for whom they have obtained jobs or hospital care 
tell only a small part of the story. Indeed, better case work is 
implied when a man secures employnient for himself than when the 
social worker finds the job. The purpose that the job or the other 
element in treatment is to serve is the important consideration. 
Thus, a family is persuaded to move to another neighborhood in 
order that the oldest boy may be better able to resist the temptation 
to join a street gang. The boy is invited to become a member of a 
settlement club so that he may be provided with a legitimate outlet 
to his desires. His mother is induced to take more care in the keep- 
ing of the house that he may find the home more interesting. The 
school teacher is asked to find what studies appeal most to the boy 
in order that opportunity for development in a congenial direction 
may be given to him. These efforts are all designed to enable the 
boy to grow to be a useful citizen. They are not ends in themselves, 
desirable though they may be. 

Again, the administering of social case treatment does not mean 
that the case worker must fulfill the function of nurse, teacher, 
clergyman, or housewife. To open the opportunity of health to a 
man one need not be a physician or do the work of a physician. 
Recognizing the importance of health to the well-being of the in- 
dividual, the case worker's task is to help the family to realize this 
also, and then if necessary to suggest the place where the essentials 
of health may be obtained. Similarly, the case worker by intro- 
ducing the clergyman or the friendly visitor endeavors to provide 
the spiritual and personal influence which her diagnosis shows that 
the man, or the woman or the family needs. It is not necessary for 
the case worker to be able to teach a housewife how to cook or to 
scrub. Case workers have scrubbed floors and cooked meals for 
families under treatment, but when a case worker has done this it 
has not been for the purpose of teaching the family how to do these 



6 The Annals of the American Academy 

things but for the influence which such an action might have upon 
her relationships with the household. 

This must not be understood to be an underestimating of the 
importance of health, education, mental hygiene, work, play, home 
economics and spiritual influence as ends in themselves. To obtain 
them is so important that more and more attention must be focused 
upon them if social case treatment is to realize its opportuniticB. 
Indeed, it is most desirable that effort be made to change the method 
of recording case work in order that the need for these things may 
be emphasized even more clearly. Porter R. Lee has criticized the 
case record as being too much a diary of how the case worker has 
spent her time and too little a statement of facts upon which treat- 
ment is being based. It might well be rearranged so as to segregate 
the various steps that are necessary to develop the personal equip- 
ment and the environment of the family under care. Thus the case 
worker in looking over the reports of her work would be able to see 
at a glance whether or not the need for work, play, health, and the 
like had been supplied. 

The opportunities which may make it possible for the individual 
to readjust his life having been pointed out to him there remains 
the last element in social treatment — motivation. Often the strong- 
est motive operating upon a man is the misery of his own predica- 
ment. This motive may be the knowledge that someone cares, 
that there is someone interested in seeing him make good. There 
is not one of the myriad impulses which influence men to action 
that the social worker is not called upon to use. The supreme art 
of treatment is knowing what motive to use in a particular situation. 
Perhaps the best preparation for a proper choice at such a time hes 
in a study of the daily experiences that mark the cburse of case work. 
What is it, for example, that caused a family to become self-support- 
ing after years of dependence on the gifts of neighbors? Why is it 
that a man who has been a drunkard since his youth suddenly de- 
cides not to touch alcohol again and holds to his decision? What 
has caused a woman who has neglected housekeeping to take a new 
interest in the care of her home? What induced the truant to re- 
turn to school, the deserter to support his wife, the consumptive to 
go to the sanatorium which he had been resolved to see no more? 
Study in other fields should also prove suggestive. Whatever voca- 
tions have to do with the art of dealing with people can make a con- 



Oppoetunities of Social Cask Tbeatment 7 

tribution to case work. The teacher the neurologist, the student 
of the psychology of behavior, the salesman will all be of help. 

Perhaps of these the art of the salesman seems to be the most 
remote from that of the social worker. Yet the imderlying philos- 
ophy of his method is the same as that of the person who is trying 
to help families. The salesman's effort is to make the prospective 
customer conscious of his need of the article that is to be so|d. Hav- 
ing created a demand, or if one exists already, having called atten- 
tion to it, the salesman shows that his goods will fill that demand. 
Then he clinches his order by giving reasons why the customer 
should buy, and buy immediately. Thus he uses the predicament, 
sometimes artificially constructed, the way out and motivation. 
The psychology of salesmanship has indeed many suggestions for 
the case worker. One suggestion, however, it must not have. 
That is the conception of compulsion. The salesman is obliged to 
bespeak his goods with all the energy at his command. He wants 
the customer to take his, i.e., the salesman's way out. The case 
worker, on the contrary, does the best work when, having faced a 
man with the facts of his situation, she urges him to plan his own way 
out. Only when the man is unable to suggest a plan of his own does 
the case worker propose a remedy. When possible, she suggests 
several remedies so that in making a decision the man has a choice. 

Moreover, the days when the case worker forced her opinion 
upon a family are passing, if indeed they are not already past. Is 
not the use of discipline in the withholding of relief often a confes- 
sion of the inability of the 'worker to suggest motives that will 
encourage a man to act for himself? The best social case worker is 
she who has the greatest faith in people and in their right to make 
their own decisions. The more nearly motivation becomes not a 
forcing of the will of the case worker but an inspiration and en- 
couragement by her to the man after his decision has been made, 
the more it approaches the true ideal of social case treatment. 

The art of social case treatment, then, is threefold. It starts 
with making clear to the family or the individual the nature of the 
predicament and what that predicament involves. It continues by 
showing a way or ways out of the trouble and it concludes by appeal- 
ing to the motives which will help the person to decide to master his 
predicament and to carry out that decision. 

The opportunities for social case treatment lie in the recognition 



8 The Annals of the American Academt 

that such a thing as social case treatment exists, and that it is for 
the purpose of social case treatment that investigation and diagnosis 
are made. The development of social case treatment depends 
largely upon the interest with which case workers analyze their own 
work and profit by experience in alUed fields. They may, indeed, 
learn much from such examples as that set by the soldier in the 
recruiting oflSce. His success, crude and unpremeditated though it 
was, is suggestive for the future of social case treatment. 



CASE WORK AND SOCIAL REFORM 

By Mahy Van Kleeck, 

Director of the Women's Division, Industrial Service Section, 
Ordnance Department. 

The case worker is authoritatively defined as one who plans 
different things for different people. The social reformer, con- 
sidered as one concerned with movements rather than individuals, 
aims to secure an identical benefit for an entire group. The case 
worker fixes attention on the individual. The social reformer 
devotes his energies to the conditions of the community. In in- 
terests, immediate purpose, method, and even in spirit and phil- 
osophy, the two would seem to be far apart. Far apart they some- 
times seem to each other. The social reformer accuses the case 
worker of blindness in attending exclusively to the immedate task 
ahead, — patching up his neighbor's affairs without changing the 
conditions which have caused his misfortunes. To the case worker, 
on the other hand, the social reformer seems sometimes to be a 
dreamer^ thinking about a changed order and neglecting the people 
who now suffer from it, and who must be reckoned with in an effort 
to change it. 

To the outsider these distinctions would probably seem to be 
a mere quibble, lacking in significance, or at best merely a portrayal 
of contrasts between two types who must together make up a 
world. To the social worker, however, it frequently becomes a 
practical question how most wisely to proportion the emphasis 
given to the mass movement and to the individual in trouble. In 
social work as a whole, if we may view as a whole so diverse and com- 
plicated a set of activities, a fruitful relationship between the two 
types of effort is a practical necessity. The case worker must be 
blind who can see no possibility of social and organized effort to 
change the conditions surrounding one individual after another 
whom he aims to help. The social reformer who does not draw his 
conclusions from the actual experience of individuals is in danger of 
being an unsafe guide in social action. 

Granted, however, the necessity for a two-fold view of the indi- 
vidual and the mass if progress is to be made, practical questions 

9 



10 The Annals of the American Academy 

arise as to how this relationship can be achieved. The word "co- 
operation" is not enough. Its terms need analysis in connection 
with the concrete tasks which the social case worker, or a re- 
former of conditions, has set for himself. Two of these large tasks 
may serve as illustrations, — the public health movement and 
industrial reform. Certainly sickness and a low standard of living 
would be regarded as giving rise to a large proportion of the prob- 
leniis of the social worker. 

Health, or the lack of it, has made necessary the care of the sick 
as individuals, institutions caring for groups, ofl&cial departments to 
protect the community, educational campaigns to train individuals 
in the care of their own health, and bodies of laws estabhshing safe- 
guards, or controlling conditions, such as quarantine regulations or 
sanitary codes. The social and economic effects of sickness have 
resulted in plans for health insurance, which mark a new phase of 
effort in the health movement. The health movement in its social 
aspects is a part of social work, broadly conceived. In its medical 
aspects it affords an illuminating parallel. Medical research is to 
the practicing physician what social research should be to the case 
worker. Individual experience should be both a source of informa- 
tion and a goal of effort. Facts gathered in daily practice may be 
the basis of laws which in turn are a guide in daily practice. The 
case worker is both an observer and a practitioner. The social 
reformer may be a research student studying the laws of social re- 
lationships or a propagandist, — a practitioner for communities 
instead of for individuals. 

The health movement, like other social effort, has three main 
branches: research for the discovery of knowledge; education, in- 
cluding the training of individuals and the dissemination of knowl- 
edge; and reform, or the change in conditions producing disease. 
It is significant that neither the case worker nor the social reformer 
would wish to be denied a share in any of these three branches of 
effort. Each of them, too, has its starting point in individual ex- 
perience, while the individual is the final test of achievement of the 
ends sought. 

The effort to prevent tuberculosis is a good illustration. Medi- 
cal research showed this to be a disease curable and preventable 
largely through education of individuals and through control of 
their environment. Thus its cure and prevention are essentially 



Case Work and Social Refoem 11 

tasks for the joint efforts of case workers and social reformers. 
Certainly organizations concerned with individuals and families 
have had an important share in the development of general educa- 
tional work, and in the establishment of sanatoriums. On the 
other hand, social reform in relation to the prevention of tubercu- 
losis, which we think of as including both public education and 
efforts to improve working and living conditions, has estabhshed a 
certain foundation for case workers. < 

In the prevention of tuberculosis, however, as in all other 
public health work, neither case workers nor social reformers have 
finished their tasks and it is the unfinished task which challenges 
them to more united effort. Tuberculosis is essentially a disease 
of poverty, fostered by under-nourishment, by congested quarters 
for living, by long hours of work, by dust in workshops, by lack of 
fresh air, good food, and exercise. The accumulated experience of 
all the case workers, if it were really to be made to appeal as it 
should to the public imagination, would be an irresistible force in 
changing for the better the present conditions of life and work. 
One reason why the task continues to be unfinished is that the 
individual experience is not made to count as it should in social 
reform. 

The same lack is illustrated in industrial reform, and the many 
obstacles in the way of its accomplishment. It is a temporary 
or permanent inability to maintain a normal standard which con- 
stitutes the characteristic problem of the case worker. Thousands 
of case workers in many parts of the country are trying to see the 
way out in this problem as it recurs day after day. It is met in 
good case work by the establishment of new relationships for the 
individual, or the vitalizing of old ones, and by a general sharing of 
burdens, as well as by a new stimulus to the individual. The ap- 
portionment of burdens, however, is not always clearly appreciated. 
The time is not long past when charitable societies and relatives 
bore the whole economic burden of industrial accidents. Now in 
many states, in Workmen's Compensation Laws, it has been recog- 
nized that industry must meet the consequences of its own hazards. 
Health insurance is advocated for the same reason,— to bring about 
a more just apportionment of burdens. 

The significant fact about health insurance in relation to this 
discussion of case work is that case workers have contributed so 



12 The Annals of the American Academy 

little to the movement, either in the way of warning or reinforce- 
ment. Full realization of what sickness means as a cause of pov- 
erty should have led long ago to a far more effective organization of 
the community for preventing sickness and for dealing with its 
results. On the other hand, the case worker, with a knowledge of 
all the comphcated factors which are involved with sickness as a 
cause of poverty, could check too great optimism as to the prob- 
able results of any one plan of 'reform. The case worker can con- 
tribute information to social reform, and to this end careful records 
and frequent and regular interpretation of their meaning are ob- 
viously necessary. But case workers can contribute something 
much more important and somewhat rare, — a constructive imagina- 
tion. Just because they deal so constantly with real conditions, 
they may be in danger of growing accustomed to them and forgetting 
any possibility of change. Case workers cannot be content with 
accepting the established standards of the community, if they 
are to contribute their share of planning and acting to bring about 
desirable changes. But the social reformer in contrast must be 
watchful of a tendency to forget that a plan is not enough, and that 
it must bear some relation to established standards and the accus- 
tomed habits of mind in the community. 

The war, with the violent changes which it produces in na- 
tional life, demands the constructive imagination in social work. 
The goals of effort in the past seem to be swept away. Those 
whose work has been the precise carrying forward of a program are 
aghast at the apparent destruction of the things for which they have 
struggled. Change in purpose which becomes inevitable seems to 
be a compromise in principle. Rehabilitation of family life is now 
opposed by the nation itself, whose demands show a claim greater 
than family life. Social reform seems to be a mockery when all 
effort for individual welfare must now be subordinated to the 
national good. Yet a new conception of the national good and a 
new organization of forces for achieving it, may be the great op- 
portunity for a new conception of individual welfare, — ^the im- 
mediate interest of the case worker, and community welfare, — 
the goal of the social reformer. 



THE NORMAL FAMILY 

By Margaret F. Byington, 

Associate Secretary, American Association for Organizing Charity. 

There is in history nothing more dramatic than the persistence 
for uncounted generations, through changes in industrial life, 
through experiments and failures in political organization, through 
the growth, decay and rebirth of religions, of the essential family 
unit — \ 

"Oh 'im and 'er and it, 
Our blessed one in three." 

as Kipling phrases it. There has been variation enough indeed in 
the relation between the man and the woman, a relation which has 
sometimes been considered purely temporary, sometimes eternal. 
Underneath all these changes, however, we find the persistence of 
the essential bond, the physical dependence of the child on the foster- 
ing care of the mother and the reliance of both on the greater energy 
and courage and physical freedom of the father for protection and 
for sustenance. 

The family as a unit has indeed functioned in many ways dur- 
ing these centuries; it has been the religious unit, especially in an- 
cestor worship, the father serving as priest; it has been the prop- 
erty holding unit to which the right of inheritance was limited; it 
has been the industrial unit, the household forming a cooperative 
enterprise; it has been the educational unit, the custodian of the 
earlier experiences of the race; it has provided for the physical 
nurture of the child. It has varied in form and in legal status, 
moulded by changing industrial, social, and religious life. It has 
likewise been a factor of great value in securing stability of progress, 
on the one hand by preserving the traditions and experiences of the 
past, and on the other, by securing within the shelter of the home 
the chance for greater variability. If we are to understand the 
moderniamily we must see it in its relation to this historical devel- 
opment. By noting which characteristics of family life have per- 
sisted through these changes, which have weakened and which 
grown stronger, we get a truer idea of what does, indeed, con> titute 

13 



14 The Annals of the American Academy 

a "normal family." In other words we shall not identify the "nor- 
mal family" with the ideal family or with any one of the varied 
types of family life now existing in our own country. We shall 
attempt lather to express it in terms of certain fundamental personal 
relationships and habits of life and thought, which have char- 
acterized family life throughout its history. 

Primitive Family Life 

Students of the family have disagreed widely as to what was 
probably its earliest form. Their theories have been based on his- 
torical documents which throw light on early family history or on 
reports of conditions among present day savage tribes. But even 
these sources are difficult of interpretation. We do not, for in- 
stance, know whether modern savage tribes are not degenerate 
rather than primitive groups; whether in fact, as Mrs. Bosanquet 
suggests, they did not fail to advance in civilization just because 
they had not developed a sound form of family life. 

There seems to be, however, a growing tendency to agree that 
the primitive family, in all probability, resembled somewhat the 
unit which exists among those apes which are closest to man in 
type. The meat eating animals find little advantage in group 
activity since hunting, to be successful, must be carried on by in- 
dividuals. So we find among certain apes, a very simple family 
unit: the female caring for the child during its period of weakness 
and helping to provide food by seeking roots, nuts, etc., near the 
home; the male, possessing freedom and greater energy and mobil- 
ity, providing the main food supply by hunting, and serving as 
protector to the female and her young. This probablj- indicates 
the status of the primitive family, a temporary union, but one which, 
while it lasted, presented already those elements which have always 
constituted the basis of family life: the protection and care of the 
weak, the provision for physical maintenance, the joint sense of 
responsibility for the children. In other words, even this elemen- 
tary family life had a psychological as well as an economic basis. 

The great significance in the development of the human race of 
even this simple family unit has "been stressed by Prof. John Fiske. 
The willingness of father and mother to sacrifice personal freedom 
for the care of their offspring made possible the prolongation of the 
period of infancy. While a chick can begin scratching for its own 



The Normal Family 15 

food a few hours after it emerges from the egg, the human child can- 
not even feed itself for many months, and is now forbidden, by law, 
to try to earn its living for fourteen or sixteen years. This slow 
process of growth makes possible the variation on which progress 
depends; it gives time for education, so that each generation may 
begin its active life equipped with the knowledge won by its for- 
bears, instead of beginning over again where they began. Out of 
the prolongation of infancy in the shelter of family life, civilization 
has been made possible. 

The way in which this simple, un-self-conscious group devel- 
oped into our modern family is too long and complex a story even 
to outline in such a paper. I would emphasize the fact, however, 
that for those who are doing case work, the history o"f the family, 
and its changing status possess genuine significance. 

We may think of this development from two angles. Viewed 
externally it is a social and legal institution, comparable in impor- 
tance to our governmental institutions, having prescribed forms 
and functions. Viewed from the inside, it forms the intimate back- 
ground of the life of every individual, the most vital force in his 
personal development. 

The Family as an Institution 

First let us consider a few of the factors which have influenced 
the development of the family as an institution. As far back as 
history records, and in practically all of the present savage tribes, 
marriage is considered in some degree a matter of social concern. 
The fixing of the degree of kinship within which marriage may take 
place, the formal rites which accompany it, the limitation of the 
rights of divorce, are evidence that it was never considered a purely 
personal affair. Custom, rehgion, and law have all been invoked as 
means for securing a stable family life against the explosive force of 
personalities which refuse to be held by any tie. 

The increasing legal control of marriage probably followed the 
development of private property on a large scale, since this made it 
necessary to arrange for the control of the wife's property and to 
determine the legal status of the heirs. Property rights have had 
more to do than moral standards with the attitude of the law toward 
' the illegitimate child. Nevertheless, these legal sanctions, even 
though based on no higher motive, did stabilize family life during a 



16 The Annals of the American Academy 

' period when it might have been engulfed by the tide of lax moral 
standards. 

Another stabiUzing force has been the attitude of religious 
teaching toward the family, every, great rehgion having sanctioned 
some form of the marriage relation. The family has a peculiar 
significance in those nations whose religion is that of ancestor 
worship since on the rites performed by his descendants depend the 
man's happiness in his future life, not for one generation only, but 
for an indefinite future. In the development of the Christian 
ichurch, marriage came to be looked upon as one of the sacraments 
and an indissoluble bond. This has, of course, been one of the 
strongest elements making for stabiUty in the modem family. 
Since the separation of church and state, the civil law has regiilated. 
marriage though the religious service still serves to strengthen the- 
sense of the sacredness of the marriage tie. Families, moreover, 
tend to maintain a joint religious life and in "mixed marriages" the 
difference in rehgious faith is a potent source of instability. 

The present variations in divorce laws in our different states 
simply indicate the general questioning state of the public mind as 
to how permanent this bond should be. It is, nevertheless,, 
clearly established that the family is so important a social institu- 
tion that the law must at least control the conditions imder which 
it may be created or dissolved. The reaUty of family life, is, of 
course, based on something far deeper than legal regulation. As 
Dr. Goodpell phrases it, "Marriage grew out of the family, not the 
family out of marriage. " The law will sanction but cannot create 
a genuine family life. Marriage has always, as now, nevertheless, 
been considered a matter not solely of personal, but also of public 
concern and control. 

The Relation of Parents and Children 

Not only the relation of. husband and wife, but also that of 
parents and children has been influenced by legal and social stand- 
ards. From the beginning, the family had its bond in the weakness 
of the child and in the simple feelings of affection and responsibility 
which that evoked. Naturally, however, this affection, which was 
instinctive not reasoned, died as the weakness which called it out 
was followed by strength and independence. Observers seem ta 
agree that some sort of concern for the welfare of the child exists 



The Normal Family 17 

among savages while the children are little, though, with their quick 
passions, they are often unnecessarily cruel to them. 

Later, the relation of parents and children became a matter of 
legal definition. In patriarchal times and in the Roman and Greek 
families, we find that the child was really considered a chattel sub- 
ject to his father's will; that no individual had any standing before 
the law except as part of a family group; that absolute power for life 
or death often rested with the father who was also priest and judge. 

This tradition has, of course, given way until modern law 
restricts in many ways the rights of parents over their children, yet 
also calls for increased responsibility on the part of the parents for 
giving their children proper training. An enlightened court, for 
example, will take a child away from his parents' control if they 
persistently fail to provide a public school education or badly needed 
medical care. The training of the child is now considered a matter 
of joint concern on the part of state and parents, the former requir- 
ing the latter to live up to the major responsibilities for its welfare. 
Law, which formerly buttressed the family as a property holding 
unit, is now concerned rather with its educational and cultural value. 

This change in the law's attitude toward the responsibilities of 
parents for their children is in part the crystallization of a new ideal 
of parenthood. 

In looking back on primitive life, we perceive a great reversal 
in the relation of parents to their children. Aside from the feeling 
of personal affection children were then consciously desired mainly 
for their service to their parents; now parents center their efforts 
and ideals on the future of their children. In the early family chil- 
dren were desired because, economically, they were an asset, either 
in the household and industrial activities of the family, or later, as 
wage-earners; religiously because there would be no happy life after 
death unless there were children to carry on the ancestor worship. 

Now, a man struggles to earn enough to give his children op- 
portunities for education and for development which he missed. 
We are even attempting to restrict marriage to those who are capable 
of passing on a sound physique. The modern family is more and 
more centering its emphasis on the future of the race. It is, how- 
ever, well for us as case workers, to realize that this is a recent change 
in the angle of vision and that especially on the economic side the 
old attitude still persists. 



18 The Annals of the American Academy 

The Ndrture of Child Life 

A social worker who is a grandmother said to me the other day, 
"I resent it so when people speak of children as a burden, they are 
the great joy of life. I often think that the very poorest of our 
families have in them the elements of the greatest joys, — the love 
of man and woman and the presence of little children, — if they only 
knew how to take advantage of them. " 

Out of this interest and this joy in caring for children in their 
weakness and watching that weakness grow to strength, family life 
came into being, and has persisted. There is hardly a home so de- 
graded that the spark is not there. Yet the question is not infre- 
quently raised as to whether the family is the best place to train a 
child or whether substitutes more intelligent cannot be found. Cer- 
tainly, experiments with the care of children indicate that in infancy 
at least, children need mothers of their own. Institutions, however 
scientific, apparently cannot give the infant just the kind of per- 
sonal attention that it needs, as their high mortality rate indicates. 
"Mothering" is of value to the delicate little mechanism. 

As a child grows older, it seems physically less dependent on 
family life, as witness the fine development of many boys who go to 
a boys' school in winter and boys' camp in summer. It may be 
doubted, however, whether sufch good physical care can be given 
anjrwhere nearly as cheaply by such institutions as in a good home. 
^ But it is for the other factors of home life, its educational value 
in a broad sense; that no substitute has been found. We shall indi- 
cate some of the ways in which the home provides essential training, 
the practical education, the growth in self-control and self-sacrifice, 
the sense ofjvalues. Because there are two parents, the family 
gives the valuable influence on both boy and girl of both man and 
woman. It provides the normal contact between one generation 
and the next. 

Economic Indkpendence 

. In the first place economic cooperation within the family has 
provided some of its greatest educational opportunities ever since 
that first primitive group that persist etl because of the need of 
mother and child for food. During the<patriarchal period the family 
reached perhaps its maximum of economic self-sufficiency: the head 
of the family surrounded by his wives and children and servants, 



The Nobmal Family 19 

together tending flocks, weaving and dyeing the wool, raising their 
simple agricultural products. Even when agriculture was devel- 
oped and people settled upon the land, so that this family group had 
to break up into smaller units, each unit tended still to live on the 
products of its own toil. With the development of industrial life 
economic continuity in famUy life remained, since the sons tended 
to take up the father's occupation. In the medieval guilds, for 
instance, entrance into a particular skilled tirade was usually open 
only to sons of the guild members. 

Following the "industrial revolution," however, changes in 
family life have come with an upsetting suddenness. The old tasks 
of our mothers have dropped from our hands and we are not always 
wise enough to find new ones to take their place. The father often 
has no trade, no sense of being anything but a cog in the industrial 
machine. The son does not tend to follow his father's footsteps; 
the son of the farmer becomes the city magnate and the son of the 
immigrant day laborer enters a profession. The family is now a 
genuine industrial unit only in agricultrual districts where women 
and children have a part in production as well as in consumption. 
The sons, too, often stay on the farm until they are ready to marry, 
and even continue to work with their father after that, and to in- 
herit the farm on his death. This state of affairs is, however, by no 
means universal, and the abandoned farms of New England now 
taken over by Italians and Slavs show the extent to which the op- 
portunities which industrial development offers have destroyed this 
family tradition. 

V The normal family is still, however, the economic unit, in that it 
has to spend only that which it earns. The pay envelope takes the 
place of the harvest. Family cooperation is expressed now in terms 
of joint spending rather than of joint production, the family pooling 
its income and meeting therefrom the varied needs of its members 
for food and shelter, clothing, recreation, etc. That this economic 
self-sufficiency has persisted throughout the history of the family 
indicates that it bears an essential and continuing part in the devel- 
opment of family lifer 

It is, in the first place, essential because of the inevitable weak- 
ness of childhood and the burdens which it entails. An occasional 
woman, who has a profession, like writing, that can be done on part 
time, can carry it on all through her married life, but the rank and 



20 The Annals of the Amekican Academy 

file of business and working women must give up wage-earning dur- 
ing the years when they are bearing and rearing children. The old 
condition which was the inital factor in creating the family, still 
holds good, namely, the dependence of the mother and the little 
children on the freedom and strength of the man. Nor to those of 
us who believe in family life, is this an unfortunate relationship. 
It is a sharing of responsibility and of work, which is the foundation 
for mutual respect and devotion. If our minds were set clearly 
enough on the significance of childhood there would be less stressing 
of the inferior condition of the woman, since hers is really the more 
important task, and the most valuable contribution which the man 
makes is to the training of the children, the wage being from this 
point of view only a means to an end, the preservation of family life. 
(I am not raising here the question of the stimulating effect on 
women of business and professional opportunity or of the wisdom . 
of remunerative work before and after the period when their children i 
need them.) 

To return to the economic problem as such. The normal 
family will depend on its own material resources, pooling the major 
part of the earnings of the various members of the family and pro- 
viding from this fund the necessities for the life of the family. Will- 
/ingness to make mutual sacrifices and the power of adjustment to 
I others' needs grow out of this necessity for sharing in the income 
1 and subordinating one's own desires to those of the family as a 
\ whole; the oldest son who works at a thankless task that his younger 
brothers may go to coUege; the mother whose chief enthusiasm in 
spending is to see that her daughter has pretty things; the child who 
is willing to carry his lunch in a box to save for records for the family 
victrola are learning self -discipline. A child who goes out into the 
world with this standard and habit of mind is not going to become 
the citizen who goes into politics for what he can get out of it. The 
^ economic problem of the family thus provides one of its really edu- 
cational opportunities. It is almost a truism that the absence of 
this realization of the rolation hetvvocn income and expenditure and 
the lack of this willingness to subordinate personal good to the needs 
of the group is one of the ^reat weaknesses in the development of 
the institution ehild. 

— There is certainly a steadying effect on expenditure wjjen the 

family's income is tlie result of the family's labor. What we have 



The Normal Family 21 

earned we treasure and, counting its value by the effort it cost, we 
want to get a corresponding value when we spend it. Income not 
produced by the work of individual members of the family never 
has this significance. In this as in other ways the family is the 
school for solving the practical problems of living. 

Edtjcation in the Home 

The family has indeed always been the most important factor j\ 
in the education of the child. 

In primitive times, the family circle was also the school. The 
Indian boy was taught by his father the wood lore knd the skill in 
hunting and fighting which was the accumulated wisdom of many 
generations; the little girl was given odd bits of leather and a por- 
cupine quill with which to imitate her mother as she made moccasins. 
Through this practical education, the parents passed on the knowl- 
edge and the skill of the race. As tribal life developed the elders 
instructed the boys in their special .cult. Little by little, as the 
amount of human knowledge increased, it became necessary to have 
wise men to pass that knowledge on. Yet not until the time of 
Christ were there among the Jews, for example, any schools outside 
the home, the family and the church being the only educational 
institutions. 

Indeed, it is only recently that the western nations have pro- 
vided free schooling for all children. Even in parts ofour own 
country school attendance is not compulsory so that large numbers 
of children still find in the home their only opportunity for educa- 
tion. Knowledge in any theoretical sense becomes then the prop- 
erty of the few, but in the home is offered practical training, father 
passing on to son the knowledge of his craft, and mother to daughter 
the secrets of household arts. 

There is perhaps no other feature in which modern life in Amer- 
ica is so changing this family tradition. The Montessori school 
takes a child at four; the out-door school keeps him for play time 
as well as for school time; the domestic science department trains 
the girl in the home duties for which apartment life and the increas- 
ing number of domestic servants give her no opportunity at home. 
In our own earlier rural life there was a simple and complete division 
of task between school and home; home training in all the practical 
aspects of life through work on the farm and in the home, and the 



22 The 'Annals of the American Academy 

"three Rs" at school. A college president is quoted as saying that 
he went to school for three months and had nine months left for his 
education. Now our schools are trying to combine the two in an 
educational system which has tremendous opportunities, but which 
nevertheless, needs to be adjusted to home life. The "visiting 
teacher" has shown the importance of individualizing the home 
background of the children if education is to be made really effective. 

In spite of the increase in the scope of the school curriculum, 
the home still provides training in many of the most important 
aspects of our lives. I read with interest two contrasting descrip- 
tions of boy life in rural communities: "Pelle, the Conqueror," the 
story of the neglect, the coarse surroundings, the hard work that 
fell to the lot of a boy brought up on a little island off the coast of 
Denmark, and the "Son of the Middle Border," Hamlin Garland's 
story of his boyhood in the middle west. They vividly portray the 
difference in the content of life resulting when the home, as in the 
latter case, provided a background of love of music and of books, of 
intelligent interest in the things of the day. 

Formal education can, it is true, overcome the lack of such a 
background, but for most children the whole future trend of thought 
is given its direction by the habits, the interests, the ideals, formed 
in these impressionable years. The home is still a most important, 
if not any longer the chief educational institution. Since the child 
learns in this school by imitation rather than by formal instruction, 
it is doubly essential that the home life be one which he may wisely 
imitate. 

The Value of Two Parents 

The part which family life has played in the development of 
personaHty, in the more subtle relationships of individuals, is diffi- 
cult to trace, as it lies so far beneath the surface. The early instinc- 
tive feeling of tenderness for the weak is at the basis of the altruism 
which now plays so large a part in our community life. In the days 
when every one outside the family or the clan was an enemy, con- 
cern for the welfare of others could be developed only within this 
narrow family cii:cle. Later, as these emotions grew in strength 
and as men were brought into closer contact with those outside this 
circle, this concern could be carried over into, and modify, the new 
relationship. This affects both parents and children. 



The Normal Family 23 

On the one hand, as Professor Tufts points out, the responsi- 
bility for training children has had a definite effect on the develop- 
ment of the moral code. Individual moral choices may result from 
a more or less unconscious acceptance of customary standards. . But 
in order to teach children what they may do and what they must 
not do, a much more definite conception must be evolved not only 
of what is right and what is wrong, but of the reasons for that choice. 
The necessity for answering that ever-recurring, "Why?" of child- 
hood, has helped to change a purely customary morality into one 
which is conscious and reasoned. 

Conversely, of course, it is in the home that the fundamental 
attitudes toward moral and social values are acquired. Here, as in 
many other aspects of family life, we see the importance of having 
two parents. The child learns from the mother those tenderer vir- 
tues of sympathy and self-sacrifice which have become synonomous 
with motherhood, from the father standards of courage and self- 
reliance. These virtues do exist in the homes of the poor as those 
know full well who have entered at all intimately into their lives, 
and are essential everywhere to the development of sound family 
life. 

We recognize this in the abstract but we often fail to see to it 
that the family lives under conditions that make this personal in- 
fluence possible. Too great a burden put on the mother's shoulders 
will break down her patience — we all get irritable when we are tired 
— and then,she ceases to be a stimulus to the child. Case workers 
should see that mothers are given a chance — a chance for recreation 
alone or with the children; decent clothing so that they can keep 
the respect of their children; and help in accepting American stand- 
ards. The settlements are wisely trying to interest children in the 
traditions of the "old country" and to teach them to appreciate the 
beautiful handicrafts. There is nothing more dangerous than the 
breakdown of the mother's influence with the older children which 
often accompanies poverty. In proportion as the mother's life is 
well rounded and possessed of varied interests will she be able to 
"train her children. 

But there is another parent and he too has an influence. No 
family is normal without a father to provide the contact with the 
outside world, the stimulus, the sterner virtues. The increase in 
juvenile delinquency in both Germany and England since the war 



24 The Annals of the American Academy 

began -bears out this conviction. Case workers need to face this 
fact more clearly, and recognize that where this influence is absent 
a substitute for it must if possible be provided. During the war, 
for instance, it might be possible for the Home Service workers to 
interest the stay-at-home men in serving, in so far as an outsider 
can, as godfather to some soldier's boy. 

Emotional Content 

If moreover, the family is to provide this essential training it 
must, we feel, not only be economically independent; it must have 
a genuine emotional background and it must have stabiUty. Two 
emotional elements have been woven together into the texture of 
family life : the original sex impulse drawing together the man and 
woman, and the instinctive love for the child. Not only were they 
essential for the creation of the primitive family; they have been 
dominant elements throughout. They have modified each other, 
the sense of joint love and care for their children being probably the 
strongest factor in maintaining a permanent relationship between 
the man and the woman, the love of father and mother for each 
other influencing their attitude toward their children. (There is a 
noticeable difference in this respect in the attitude of parents to- 
ward adopted children where this emotional content is absent.) 
Without this emotional background serving to cement family life, 
the inevitable antagonisms and conflicts that must occur at times 
in any group living in such close contact would often cause its 
disintegration. 

This may seem obvious, yet it again needs stressing in a con- 
sideration of the family for case workers. Do we consider enough 
how absolutely fundamental this emotional element is in maintain- 
ing family solidarity? Just as an illustration, — we are deaUng with 
the family of a non-supporting husband and we urge the wife to 
take court action in order to force the man to resume his financial 
obUgations. Do we always consider whether this is not going to 
destroy absolutely the emotional factors in the family life and do we 
consider it a last resort not a first one? Obviously we must, at 
times, utilize this means to bring a man to his senses, but do we 
often enough stop to ponder on the relative significance of emotional 
stability and economic independence? Do we often enough utilize 
the man's instinctive devotion to his children as a means of grace? 



The Normal Family 25 

It is perhaps unnecessary to say that there may be at the other ex- 
treme an overstressing and sentimental attitude toward the relation 
•of man and wife and children. Books, however, like "The Poor 
Man's House," and Miss Loames, "The Queen's Poor,"i indicate 
that there is throughout modern industrial life a sound underlying 
devotion and joy in family life on which we should more largely 
depend in family planning. It has, it is true, a physical and in- 
stinctive basis, but on that very basis, a genuinely spiritual struc- 
ture may be reared. 

It is, moreover, another element in family life which we must 
•especially reckon with just now. Tremendous emotional adjust- 
ments are necessitated by the departure of the soldiers. The ex- 
periences in Canada in which intemperance and immorality are 
unfortunately not infrequent among wives of soldiers, heretofore 
women of irreproachable character, show what utter breakdown 
may result from this change in the emotional content of life; the 
substitution on the one hand, of strain and anxiety for the sense of 
assured protection and genuine comradeship, on the other, the 
sense of new freedom from control. 

If we are to be truly helpful in tangled family situations we 
must reach a sympathetic understanding of the emotional elements 
involved and attempt either to strengthen normal relationships, or 
where that is impossible, reckon the effect on the whole life of the 
family of the absence of this fundamental factor. 

Family Stability 

That a stable family life in which the child may secure its physi- 
cal and moral development is necessary, is a conviction probably 
accepted by all case workers and one which is in our opinion borne 
out by the whole history of family life. If we believe that the mu- 
tual dependence of family life has been an important element in the 
growth of morality; if we believe that practical education in the 
home is valuable; if we see in the home a place for the nurture of 
spiritual life, we must recognize that permanence is essential. 

There is, however, a change in the conditions which have kept 
the family stable. Some of these conditions were the economic - 
usefulness of the family group, its relation to the holding of prop- 
erty, its religious significance. Of these, the second, the necessity 
'See especially the chapter on "Husband and Wife." 



26 The Annals of the American Academy 

for safeguarding property rights, has probably been the largest 
factor in creating legal safeguard for the family group. Yet, in 
this country, property rights have almost ceased to be a factor in 
maintaining family unity, — in fact, in the propertied class divorce 
is very frequent. 

Since these earlier safeguards of family integrity are weakening, 
it behooves those who beheve in its value to use every means to 
strengthen it through the development of its educational and cul- 
tural activities. 

The Normal Family 

We have attempted to sketch in outUne certain elements in the 
complex history of family life and the forces which have molded it. 
The significance of this development to the case worker seems to 
me twofold. 

We talk rather easily about "restoring famihes to normal liv- 
ing. " We shall be more likely to achieve this without harm to the 
delicate fabric of family life if we see the family as a growing, devel- 
oping unit of which its present form is only a stage and realize the 
process by which it has arrived here. We need to know the extent 
to which the father has been priest as well as provider; the family 
the center for moral and secular education; the way in which local 
customs passed on by the family have formed the basis for much of 
our morality and common law. With this background of under- 
standing, we shall be keener to study "our families," not simply as 
econoniic units, failing to function, but as the complex basis of the 
moral and spiritual life of the individual members. That surely 
adds to the complexity of our task, but adds also to its significance. 
Some other economic adjustment of human life is entirely possible, 
and has been portrayed delightfully in many of the Utopias, with a 
purely individualistic and transient relation between men and 
women and with the children provided for through public institu- 
tions. But the family has been not only the economic unit but the 
largest single factor in the development of the altruistic and spiritual 
factors in life, and for the stimulation of those elements a substitute 
is hard to find. 

In the second place it lays upon the case worker the necessity 
for studying the reaction of industrial and social changes on family 
life. We are more self-conscious than our ancestors and more keen. 



The Normal Family 27 

therefore, to watch the results of our own social experimentation. 
The thoughtful study of individual families will indicate the extent 
to which modem social institutions foster or destroy the proper 
functioning of human life. Through skilful observation of family 
problems we will find the sanest background for a developing social 
program. 

Case Work and the Family 

There is need, moreover, that we recognize the elements in our 
communities which tend to break down this normal family life. 
That it has tremendous vitality is indicated by its survival through 
all the vicissitudes of history. But that in individual cases it does 
fail ,to function is too obvious to need stressing. Sickness, inade- 
quate wages, bad housing, intemperance, immorality, all these and 
many other factors break down this finely adjusted institution. 
Some of these are factors outside the family itself, for which the 
community is responsible, and which must be removed by com- 
munity action. More and more we recognize how many times 
family breakdowns may ultimately be traced back to unwholesome 
external conditions such as these : a tenement so small that there is 
no place for real family gatherings; a father whose hours of work 
are so long that he cannot share his children's lives ; an income too 
small to make joint recreation possible; these and many like factors 
nullify the truly educational possibilities of the home. It certainly 
is a task for those of us who believe in the value of this family unit 
to study ever more searchingly the conditions which tend to 
lessen its value in the development of the child and to endeavor to 
overcome them. 

In addition there will always be the task of trying to help re- 
establish as nearly as may be, the homes where family life has failed 
to maintain itself either because of external conditions or because of 
an internal breakdown. Every home so reestablished means a 
sounder background, a better training for each child in it, so that 
oui task has genuine social significance. It is, nevertheless, a task 
which will be approached in humility of spirit, if we realize of how 
varied and subtle strands normal family life is woven, and how deli- 
cate is the task of so readjusting them that they will form the perfect 
pattern. 



OFFSETTING THE HANDICAP OF BLINDNESS 

By Lucy Wright, 
Associate Director, Boston School of Social Work. 

The present stringency of the labor market has opened up 
opportunities for the present, at least, for use of handicapped labor, 
as never before. Among returned disabled soldiers it is so probable 
that there will be a certain number of blind men, that the govern- 
ment has already prepared a plan for their reception and special 
training. It is especially worth while, then, at this time, to try to 
formulate some fundamental principles of social case work in read- 
justing industrially men handicapped by blindness. 

Foremost among these is the principle that all the work must be 
work with and not /or the blind. If the "give and take" relation is 
the essential working basis of all good case work, it is doubly so in 
work for the physically handicapped. It is quite usual for blind 
men to ask: "Will you see what you think of my case?" A man 
of rare ability with oncoming blindness may put this to you: "I 
have a year, they say, before I shall be totally bUnd. I expect you 
people to tell me how to use that year to the best advantage." 
Another may say: "I am willing to do my part, but I cannot man- 
age alone against such heavy odds. What will society do about my 
case?" 

If we are to work intelligently with the blind we must first find 
the man behind the handicap. That is, I believe, the only hopeful 
basis on which it is possible to equalize his chances in such a way 
that he may make the contribution he has to make to society, be it 
small or great. To find the man behind the handicap is not, how- 
ever, so simple a program as it may seem. 

There are, first of all, certain obstacles in the minds of the rest 
of us. Blindness is a very obvious handicap. We who are rela- 
tively whole cannot help dwelling on what is gone rather than on 
what is left in others. It takes a blind person to say, as one cheer- 
ful, successful blind woman said to me, "Why, it's not the fact that 
you're blind that counts, but only how you take it!" We sighted 
ones even "speak up loud" to people who wear smoked glasses, so 

28 



Offsetting the Handicap of Blindness 29 

vague is our concept of what may be going on behind those glasses 
in the mind of the person who simply cannot see with his eyes. We 
do not trust and understand the intellectual life without sight or 
the use of other senses as well as that of sight, and so we class to- 
gether men who cannot be classed together in any other respect 
than that of the physical handicap ,they suifer in common. 

The very existence of organized work with the blind from nur- 
sery to special work shop, encourages the tendency to lump the blind 
in a class. The best efforts of the best workers, blind and sighted, 
have not been able to offset the danger, and will not be unless, at 
this moment, when a share of the world's attention is turned to the 
physically handicapped, we succeed in "putting over" some such 
idea as I have suggested. 

This idea will not be particularly pleasing to those among the 
blind and their sighted champions who believe that blindness is in 
itself a quaUfication for special consideration for it cuts right through 
the whole exploiting design. It removes the basis for either emo- 
tional or exclusively political handling of the industrial affairs of 
the blind. Without doubt the most serious obstacles to the devel- 
opment of a plan of work with the blind, on what a blind man has 
called "the something for something" basis, as against the "some- 
thing for nothing" basis, lie in tendencies of both blind and sighted 
supporters of this cause to exploit the situation of the blind for 
emotional and political values rather than to develop it on the basis 
of a reasonable efficiency. This is regrettable, not only on eco- 
nomic grounds, but because it puts the blind and work with the 
blind on a false, unstable and temporary basis, and cannot, in the 
long run, bring them happiness and usefulness. Emotional exploi- 
tation is usually the fault of the sighted. Political exploitation is 
more often the fault of the blind, and the measure of success or 
failure of work with adults depends very largely upon the leader- 
ship in this respect within these two groups. 

The great advance made in every department of social work in 
the direction of tests and estimates of individuals has greatly im- 
proved the quality of social case work with the blind. 

This is illustrated in the department of education of blind 
children, by the work of Robert W. Irwin in the public schools of 
Cleveland, Ohio. Here we see the prospect of equahzing chances 
in life for physically handicapped children, not only by giving them 



30 The Annals of the American Academy 

equal opportunities with sighted children, but by sifting within the 
group the sub-normal from the sound and training them appro- 
priately. These are first steps. The principle needs only to be 
carried further in work with adults, and made to cover character 
as well as mental and physical tests, until we acquire a basis for and 
skill in estimating the possibilities of individuals, in time to be of 
service to them and to the community. One example of a move in 
the direction of this testing-out principle is illustrated in work for 
adults, under the Massachusetts Commission for the Blind, by the 
effort to use home-teaching of the blind as a preliminary try-out 
before shop training. This plan makes occupation therapy a test, 
if not a step, in pre-vocational training of blinded adults. 

The need for securing a real basis for social case treatment of 
employment problems of blind men by coordinating the various 
lines of effort in adult work through some such central agency as 
state commissions or federal boards has been forcibly illustrated in 
the plans worked out for disabled soldiers in various countries since 
the war. The program includes orderly use of curative occupations, 
vocational reeducation if necessary, and placement in accordance 
with ability, whether in competitive industry, home occupation or 
subsidized shop. Such an orderly technique presupposes coordina- 
tion of forces in the industrial service of the bUnd, not on a basis of 
philanthropy, but of public educational and vocational service. 

It must never be imagined that the principle of "finding the 
man behind the handicap" will minimize the amount or expense of 
work to be done. It is only a means of finding out what are a per- 
son's potentialities for the sake of reasonable economy, efficiency 
and, most important of all, for the happiness of the handicapped. 
This plan for individuaUzing may, on the one hand, be regarded as 
a protest against the unnecessary and harmful expedient of "trying 
to make a silk purse out of a sow's oar. " A thinker with a scientific 
mini! points out that this attempt, too common among social workers 
in what are still pioneer days, not only taxes the worker and defeats 
its own purpose, but too often destroys the possibility of a perfectly 
good pig-skin purse. It may, on the other hand, be regarded as a 
protest against the waste and unhappiness resulting from misuse of 
fine minds and natures in inappropriate work. This is felt most 
keenly in observing the lives of well-trained, intellectual blind 
people, for whose good energies society with its prejudices furnishes 
no outlet in effective work. 



Offsetting the Handicap of Blindness 31 

Individualization of the handicapped involves continuous 
Tecognition of the difference between those who are and those who 
are not capable of industrial aid. It involves distinctions among 
the forms of industrial aid, but requires always the same underlying 
principle. Society says to the handicapped man, "You keep up 
your end in proportion as you can, — we will keep up ours in propor- 
tion as is necessary, in order that you may make the contribution 
that is in you, be it little or much." This is the "something for 
something proposition" which must lie behind every form of indus- 
trial aid for the blind. To carry it out we need (1) to work out an 
orderly technique of social case work that is as acceptable and 
understandable to a handicapped man as to the sighted worker with 
the blind; (2) to provide by way of background a campaign of 
education reaching family, neighbors and employers in every 
community to which disabled men return, whether they are the 
victims of disease, industrial accident or war. 

The difficulties of finding the man behind the handicap are 
many and various. It may be that he can be discovered early by 
some very simple touch. On the other hand it may take years to 
find the man behind the handicap, and then his contribution may be- 
so shght that the subsidized shop may be obliged to meet him not 
only half-way, but more, if he is to "do his bit." 

The fact that a physically handicapped man finds himself in 
the almshouse is no proof that he lacks skill and character. But it 
is well to try by actual test whether he has skill with his hands, as 
well as to make sure whether he has the force of character to stand 
up in the community. Raising of false hopes is one of the unkind- 
nesses to be guarded against in all work with the handicapped. 
The temptation is great. For the almshouse population, the visit- 
ing home teacher who by actual try-out can test the mind and skill 
of hand of the individual, and form a just estimate of his character, 
is an essential part of a safeguarding plan. Through such a worker 
we make occupation therapy and pre-vocational testing a reality in 
work with adults. Massachusetts had been especially fortunate in 
her state home teachers (blind), and one among them has an especial 
gift for finding the good human qualities that lie behind the handi- 
cap of blindness, as well as the ability to read with the fingers and 
learn simple manual processes such as netting and basketry. The 
following is her own account of such an instance : 



32 The Annals of the American Academy 

Another man, formerly at the State Farm, was there because while trying to- 
earn a living at canvassing, after losing his sight, he had been roTjbed of his wares 
by a dishonest guide. He placed himself in the poorhouse, and had been trans- 
ferred to the State Farm, where I found him. In the four months of instruction 
he learned to read and write Braille, to cane-seat and pith-seat chairs, and make 
rake knit bags. He was sent to a workshop in April to learn broom making, and 
. before his vacation in August, had also learned to weave coarse rugs. He is now 
completing his apprenticeship, and will shortly find a place among the blind wage- 
earners. He has made since July first about fifty rake net bags and sold them,, 
receiving between forty and fifty dollars for his work.' 

Then there is the man who meets you more than half-way. 
You are being tested rather than he. How can you help him con- 
tribute all that is in him to give? This kind of man is healthy, in 
mind, body and spirit. He simply lacks the use of one sense- 
organ. He requires no long period of readjustment. He masters 
one hand process after another. He had trade-training behind him 
before he lost his sight, and is confident that he can, with backing 
and special equipment, follow his old vocation of florist, in which he 
has had twenty years' experience. Your job as a social case worker 
is with possible employers and backers, and not with the blind man. 
It is not a question if he will "keep up his end, " but whether society 
will keep up its end. You must prove by actual experiment, and 
you can do it only with the feiid of some florist of standing, that this 
man can actually do without sight the processes he did with sight, 
and that there will be a market for his labor, if he is provided with 
the necessary capital and tools with which to work. The story of 
how this particular man developed a greenhouse, with crops of 
chrysanthemums, tomatoes, mushrooms, etc., and of how, when the 
fuel shortage compelled him to close down, he turned successfully to 
competitive factory work cleaning bobbins in a worsted mill, is full 
of interest,— but what I have told is perhaps enough to suggest the 
variation in peace problems of employment of blind men. 

The variation among disabled soldiers promises to be in some 
ways greater, in others less, — less, because the men are already 
sifted by certain mental and physical tests before they go to the 
front; greater, because of the chances of other physical handicaps 
in combination, perhaps quite different from those appearing in 
problems of civilian life. Greater, too, because among oflScers and 
men, this disability may cut across we know not what range of men 

> Massachusetts Commission for the Blind, 1 1th .Annual Report 1916-1917 



Offsetting the Handicap of Blindness 33 

of talent. The plans so excellently carried out at St. Dunstan's, 
England, for soldiers disabled by blindness, and the carefully laid 
plans for American soldiers who may be so disabled, all provide for 
curative occupation early. Visitors from St. Dunstan's go to the 
blinded in hospital wards early "for good comradeship." All of 
the nurses, including the superinterident, in some of our base hos- 
pital units have voluntarily equipped themselves with knowledge of 
principles and practice of occupation therapy, and the government 
has laid careful plans for each succeding step to the point where 
the handicapped individual comes bacfi to live out his life in the 
community. 

Canadian experience tells us that the principle of helping a 
man back to his former vocation holds in 90 per cent of cases of all 
disabled soldiers in Canada. Only 10 per cent need complete re- 
education. Placement takes on a new aspect when the country can- 
not afford to lose the labor of a fraction of a man. Work for the 
handicapped is transformed, and it is for us to see that the basis of 
transformation is brought over permanently into our community pro- 
grams. Only ignorance of the true possibilities for individuals, and 
the dangers of emotional and poUtical exploitation stand in the way. 

In the meantime, for the worker with individual cases, there are 
suggestions out of past experience that may be helpful. The in- 
formal use of some simple classification, in arranging all the facts 
about the man and the situation may help both the man and the 
social case worker to face things together. Dr. Southard's discus- 
sion of classification in his course on Social Psychiatry at the Boston 
School of Social Work this winter has stimulated many of us to put 
in more orderly shape haK-crystallized ideas and methods in social 
case work. The plan outUned in the footnote for rearrangement 
of all the facts in the situation is one we are in process of trying 
out at the School both as a help towards making a plan and getting 
at larger implications.^ ' It presupposes that all the necessary facts 

2 Social Diagnosis, Social Case Work and Problems of Unity, Stability, Bal- 
ance or Adjustment in situation of Unit: 

Individual Classification of information about unit: 
1. Self Defects ~ Powers 

Physical, viz. 
MentaJ, 
Psychological, 
Character, 
(apparently) 



34 The Annals of the American Academy 

have been gathered and recognized, and that only questions of actual 
diagnosis and trjeatment remain. It seems to be most helpful in the 
matter of proportions and emphasis. The individual as unit, and 
the offsetting of defects by powers are perhaps the most important 
points about it in relation to the blind. 

In speaking to various groups this winter, students and others, 
it has seemed to me that it was more important to direct them to 
acquaintance with the life stories of handicapped individuals — in 
fiction (when truly interpretative), in biography, autobiography 
and in fact — than it was to dVell on points of special technique, in the 
education and employment of the bhnd. Nothing will replace this 
knowledge. The part of the blind in work with the blind has been 
its characterizing feature from the start. Often the best thing you 
can do for a newly blind man is to put him in touch with some other 
man who has been through similar experiences, and worked out for 
himself a recognized place of usefulness and a philosophy of life. 
For suggested reading, to prepare the mind for "what blindness is 
hke from the inside out," a short list is given below.^ Many 

2. Relation to immediate environment and to others 

Environmental Defects Powers 

(immediate) 

Educational 

Industrial-Social 

Legal-Social 

Unclassified 
Diagnosis : 

Self-adjusting Requires interference 

Temporary — Continuous — ^Permanent 
Prognosis: 

Helpable from point of view of 
Treatment: 
Social Implications. 

'Suggested Reading 

KeUer, Helen, "The World I Live in." 

Montague, Margaret P., "Closed Doore. " (Stories of blind and deaf children.) 

Duncan, Norman, "The Best of a Bad Job." Har/yer's Magaziyie, 1912, p. -112. 

Hawkes, Clarence, "Hitting the Dark Ti-ail. " 

Holt, \\inifred, "A Beacon for the Blind." Tl\e Ufe of Henry Fawcett, the blind 
postmaster-generiil of England. 

The Outlook foi- the Blind, a, quarterly magazine in ink print devoted to the interests 
of work for the blind in this niul other countries; edited by Charles F. Camp- 
bell, Columbus, Ohio. 



Offsetting of the Handicap Blindness 35 

more might be given. These are selected because they seem to me 
to help towards imagining what life in the dark may be like. The 
titles, even here, often stress what is gone, like "Closed Doors" 
and "Hitting the Dark Trail." Two suggest both sides of the 
case in quite a remarkable way, — "A Beacon for the Blind" and 
"The Outlook for the Blind." The two most genuine and help- 
ful titles to me are "The Best of a Bad Job" and "The World I 
Live In." "Closed Doors" and "The World I Live In" do not 
relate to employment problems of men, but they, perhaps, set you 
right, at the start, better than any others. 

To summarize briefly, there are seven suggestions towards 
helping to find the man behind the handicap that seem most im- 
portant to "put over" at this time. They are the following: 

1. Acquire confidence in other senses than those of sight. 

2. Try to understand the real possibilities of intellectual life without sight. 

3. Consider character as well as economic values. Professor Amar has made 

this point very clear in saying, "The mutil6 possesses always a perfectly 

utUizable capacity for some kind of work He may actually 

compensate for his physical defect by an active good wiU, which'in- 
creases his social value. This is a psychologic fact which must be turned 
to advantage. '' 

4. Help the handicapped to measure themselves, not only against the handi- 

capped, but against all those with whom they must compete. 

5. Make plans for offsetting handicap on the basis not of "something for 

nothing" but of "something for something." 

6. Test the facts to be faced with some simple classification that can be talked 

over by you and the blind man together. 

7. Look for your inspiration to the lives of the blind themselves. 

General Reading with references to the blind: — 

Recalled to Life, an English quarterly, devoted to the care, reeducation and return 

to civil life of disabled soldiers and sailors. 
Reconstruction, monthly bulletin, Military Hospitals Commission, 22 Victoria 

Street, Ottawa, Canada. 
Shairp, L. V., "Refitting Disabled Soldiers, a Lesson from Great Britain." The 

Atlantic Monthly, March, 1918. 



THE CRIPPLE AND HIS PLACE IN THE COMMUNITY 

By Amy M. Hambuhgeb, 
Fonnerly Assistant and Associate Director, Cleveland Cripple Survey. 

For many generations the cripple has occupied a rather obscure 
place in the community, and has not had suflScient chance to share 
equally in all opportunities offered to normal children and adults. 
It is true that many individuals representing various organizations 
have been interested in the cripple and have helped in securing' 
proper medical treatment for both crippled children and adults in 
some communities and limited educational advantages in other?. 
Yet they have been unable, because of very apparent and justifiable 
reasons, to interpret to the community the real individual behind 
the handicap. 

However, through industrial accident boards the needs of the 
adult cripple have become increasingly more apparent. As a re- 
sult of recent infantile paralysis epidemics some of the immediate 
and pressing needs of children have also become apparent, stimu- 
lating in the community a deeper interest in both these groups. 
Although industrial accidents and infantile paralysis, — both serious 
causes of crippling conditions, — have increased the total cripple 
population, the community has not been aroused until the present 
time, to take any active steps in carrying out a constructive pro- 
gram, thus indicating their recognition of the significance of this 
group in community life. 

Now, because of the war, the care of the returned crippled 
soldier forces the community to immediate action. Already, plans 
for his medical care, for educational, vocational, and industrial 
opportunities are well organized. Everything is being done to 
assure him of a permanent place in the normal Ufe of the community. 
As a prospective idle dependent he is realized to be an undesirable 
citizen, so every chance for expressing himself in the kind of work he 
is best fitted for, by education, training, and physical condition, is to 
be open to him. It has even been said that a plan for some read- 
justment of the Workmen's Compensation and Liability Act is to 
be made, thus releasing the employer from the extra rates of in- 
surancf^ — an expense incurred by employing handicapped labor. 

36 



The Cripple and the Community 37 

All this means that the industrial world will be open to him and it 
is for him to choose his place. He will not have to face an un- 
kindly and prejudiced community because of a slight physical dif- 
ference. Such has often been the fate of the peace-time cripple. 

These new developments, naturally, have an indirect influence 
upon the future of the peace-time cripple. They assure him that 
the cripple will no longer be judged by his slight physical differ- 
ence, but by what he can offer to, the community. It is true that 
many peace-time cripples have lived out their lives heroically and 
successfully and are holding positions of responsibility. This mean^ 
that they made the most of the chances that came their way. Sto- 
ries are often told of the successful individual cripple but such stories 
have never been accumulated in any available form that might 
serve as an inspiration and guide to other cripples, and to interested 
persons in this field of work. 

At a meeting in Boston a member of the Committee on Voca- 
tional Training for Disabled Sodiers in discussing their work said 
that, at the very beginning of work before definite plans were made, 
they had asked for such material. They wished to know what crip- 
ples have been doing all these years; whether they had been suc- 
cessful in large numbers; if so, whether cripples with the same type 
of disabihty showed any tendency to follow any particular line of 
occupation; and whether they had been successful in that. Such 
contributions would have been invaluable as a guide. They soon 
learned, however, that information of this kind was not available 
in this field in the United States; therefore they were compelled to 
look to France and other alUed countries for advice. 

Social agencies, institutions, or whatever may be the type of 
organization working with cripples are the natural sources to look 
to for whatever information may be had about this group. It is, 
however, true that they are working with a limited number of 
cripples in their field and can, therefore, judge of their limitations 
and abihties by highly selected facts only. "Unfortunately, it is 
the many varieties of human failures which come as a grist to the 
social worker's mill and diagnostic studies are essential for the deter- 
mination of what can be done by this or that treatment of the 
human material at hand. '" For lack of time and funds it has not 

'"Psychology and Social Case Work" by Dr. William Healey, National 
Conference of Social Work, 1917. 



38 The Annals of the American Academy 

been the custom to diagnose an entire field of work — such as crip- 
ples — in order to get a background and learn from those who have 
no reason to come to the knowledge of any of these sources. At 
once the question might be asked if this is a feasible plan and if it 
has ever been tried. ^ 

The Cripple Survey in Cleveland 

For such information it would be well worth while to look tO/ 
the City of Cleveland, Ohio, a typical American city, which has 
made a diagnosis of its cripple problem and so knows all its cripple 
children and adults, their failures and their successes. 

A group of persons, representing five different types of agencies, 
working with cripples were interested in child welfare work; the 
general condition of the handicapped; and the industrial chances of 
the handicapped. Having reached a stage in the development of 
their work where it seemed impossible to serve the conununity and 
cripples helpfully unless they could obtain some further hght on 
their particular problem they too looked about for information on 
cripples in general, but could find nothing available in the United 
States. At this' point they were advised to diagnose the entire 
problem in their city in order to get a clear idea of what had been 
done and what was needed. This seemed a colossal task but plans 
were soon under way for a city-wide house-to-house canvas, includ- 
ing both rich and poor. It was to be a democratic survey in every 
sense of the word and looked to the Uving sources of the community 
to contribute their share to make it a successful undertaking. 

The social agencies of Cleveland, at first, thought that they 
surely knew all the cripples in their city. But after trjang out a 
fairly typical section of the city, they were convinced by the results 
that they had in the past judged the problem by limited groups. 
The same proportions of new cripples — 65 per cent unknown to 
social agencies — were found by the surveyors in all districts. A 
larger proportion of unknown crippled adults was found. This at 
once suggested that the adult cripples are not the dependents that 
one is led to think. It is so easy for the uninformed public to judge 
the entire crippled population by the unfortunate cripple who may 

'"Education and Occupations of Cripples, Juvenile and Adult," by Lucy 
Wright and Amy M. Hamburger, Published for Welfare Federation, Cleveland, 
Ohio, by Douglas C. McMurtrie, New York, City, 1918. 



The Cripple and the Community 39 

■wish to spend "his Ufe seUing shoe-strings and pencils on the street 
corner because he finds it profitable to do so. In the whole city 
about ly50,000 families were visited and the total number of cripples 
recorded, including those known to social agencies, schools, hospitals, 
homes, almshouses, etc., was 4,186. 

The response from the cripples themselves was most gratifying. 
When they were asked to contribute frOm their successes or ex- 
periences in life, to the encouragement and inspiration of others 
similarly crippled, or to tell the obstacles to be overcome before the 
cripple could be assured of any encouragement, they most graciously 
and joyously responded. Some were amazed that they should be 
considered cripples, even though they were without an arm or leg, 
or perhaps seriously crippled as a result of infantile paralysis. They 
had never considered themselves handicapped in any sense. 

I remember well my visit to a man who had lost his .right arm 
to the elbow and who was actually amused at being considered a 
cripple. His home was in a very respectable neighborhood of de- 
tached cottages. In response to my knock a man's voice bade me 
come in. I entered a large sunny kitchen, where this cripple was 
busily "washing up," as he called it, for dinner. He continued 
while he asked me who I was, where I came from, the purpose of such 
a survey, and the source of the financial support of such an under- 
taking. He emphatically said he wished to be connected with no 
philanthropic scheme. I explained everything from the purpose to 
the source of finances including the names of our committee mem- 
bers. As I finished he said, "I call that a fine piece of educational 
work, for you are not only learning about us but you are teaching 
the people of Cleveland that we are not an idle, begging lot, but 
men and women like the rest of you, with your good qualities and 
your failings, and that we want the same chance. We want you all 
to see us as we are, — real men and women with a shght physical 
difference but the same otherwise, and able to hold our own with 
you if given the chance. " He then invited me to join his wife in the 
living-room where he told me his story. 

He was one of a large family, whose parents were respectable, 
hard-working people. After graduating from grammar school, feel- 
ing the necessity of earning money and having a marked mechanical 
interest, he decided to learn the machinist's trade. Unfortunately 
at the age of 24 years, — he was than a skilled steamfitter, — he met 



40 The Annals op the American Academy 

with an accident which resulted in the loss of his arm. The com- 
pany made no settlement, as they considered the accident due to his 
own carelessness, and as he could not continue in his present work 
"he grit his teeth" and determined to use his savings for "educa- 
tional help." He took a special course in mechanical engineemg 
in a technical college, which he soon reaUzed was beyond him be- 
cause of his meager preparation. But he was not easily discouraged 
and went to an institution in a distant city where he took a course- 
in mechanical drawing. At the completion, in a year, he asked to 
be given a chance in their workshop ; they at first refused but later 
consented to employ him. Here he did all kinds of drafting. After 
a few years he went back to his home city, studied to be a first-class 
marine engineer, got his license and applied for a job. From now 
on he met his greatest obstacles. Unconsciously he had a habit of 
putting his disabled arm in his pocket and often was on the point of 
securing a much desired job, when the arm would as unconsciously 
come out of his pocket and the possibilities of work were gone. One 
day in sheer desperation, after being refused many times, he re- 
turned to one employer and said, "How do you know what a one- 
armed man can or can not do? You have never hired one. Whj' 
don't you hire one and give him the chance to show what he can do? " 
He was hired, at his own risk, as first-class engineer on one of the 
lake boats, where he remained for about 15 years. He earned $175 
a month. Because of his wife's ill-health he recently gave up 
his work. He, however, carries on a small business as automobile 
repairer and installer of heaters. He can handle all kinds of tools 
and do all the necessary processes of work in both jobs with the ex- 
ception of cutting pipes. 

' In discussing the problem of cripples he gave from his own 
experience and good judgment much helpful advice. Among other 
things he said : 

Don't judge all cripples by the loafei-s on the street corners. They are usually 
so from their own choice, or ill-advised help of their friends, and often would be 
just the same if they were not handicapped. Don' t make us a separate class. We 
are the same as the rest of you. Judge us by what we have left, not by what we 
have lost. Put aside philanthropic schemes but stand ready to give us helpful 
advice when we are first disabled. This -is the time we need it and need the right 
kind of friends. Steer us into the right occupation. Tell us about others who 
have been successful. Provide educational opportunities and training for children. 



The Cbipple and the Community 41 

This successful cripple, with his fine philosophy of life and 
determination of character was a type of many men and women 
constantly being found through this survey. Consequently, the 
first definition of cripple: "A person whose muscular movements 
are so far restricted by accident or disease as to affect his capacity 
for self-support, " was gradually abandoned and the purpose of the 
survey became: "To discover the economic and educational needs, 
capacities, and possibilities of children and adults in Cleveland who 
are handicapped because they lack the normal use of skeletal or 
skeleton muscles." This latter made it possible to carry out the 
original plan of making it a democratic survey. 

As a result of such a broad purpose, the types of handicap con- 
sidered were many, from loss of two or more fingers or a thumb, to a 
combination of most disabling conditions. This brought the work 
into a varied field of occupations, — so varied that there seemed to be 
no prevailing type of crippled persons following one special line of 
work. It is interesting to know that among 3250 persons over 15 
years of age including 400 housewives, who were considered self- 
supporting, 58 per cent were employed and they represented every 
known disability recorded. 

These industries and occupations were carefully classified in the 
hope that some further light might be found about the choice of 
occupations of the one-armed, or armless cripples; the one-legged 
or legless cripples; the cripples with other kinds of disabling 
conditions. However, the successful cripples most obviously 
adapted themselves to the type of work they were qualified to do. 
Three armless men were found following three distinctly different 
Hnes; one is a beggar, spending his time on the street corner; the 
second, a street peddler who, with reins about his neck, drives a 
small team through the streets; and the third, a judge in the Dis- 
trict Court who wrote his bar examinations holding a pencil between 
his teeth. This is his only method of writing because his arms are 
amputated close to his shoulders, thus preventing the use of arti- 
ficial arms. 

Among the legless cripples were: a beggar of fine physique, 
unfortunately, undisciplined in youth, sitting in the hotel doorway, 
asking alms under the pretext of seUing gum, and averaging from 
$15 to $30 a week, according to his mother's statement; a successful 
stenographer employed, by a real estate company, earning $17 a 



42 The Annals of the American Academy 

week; a successful salesman in the employ of an artificial limb com- 
pany earning $100 a month, who said he could run and dance Uke a 
normal man, although to the keenly observant person, a slight Ump 
and sUght stiffness of one limb could be detected. There was also 
the skillful cartoonist with a congenital paralysis of one arm, and a 
defect of one leg, whose entire life has been as much Uke that of a 
normal person's as his judicious parents could make it. So unac- 
customed was he to thinking of his handicap that he was almost 
startled when he was informed by his mother that she had reported 
him as a cripple to the surveyor. He dances, swims, play tennis 
with one hand, and enjoys the usual activities of the normal man. 

These are merely types of innumerable cripples visited in this 
survey. Each is different, showing clearly character defects and the 
variable mental attitude that plays such an important part in direct- 
ing the failures or successes of the cripple in the economic world, — ^as 
important a part as his physical disabiUty and in some cases more. 

Of the total number at work 54 per cent were earning a hving 
for themselves. Over one-half of this number were supporting 
themselves in addition to others. Only a small number of those 
unemployed were receiving industrial pensions, which immediately 
raises the question as to whether industry is bearing its just burden 
in relation to the number of accidents. 

The number unemployed, of course, was greater among those 
having the heaviest kind of handicap although large numbers of 
those with serious disabilities were at work. The man with double 
club hands and club feet illustrates the latter type. His parents 
were Polish immigrants who were illiterate and who never learned 
to speak Enghsh. This man was the oldest of 21 children born in a 
remote town in Kansas. Although his parents reaUzed his deform- 
ity, no doctor was consulted until he was about five years old — his 
mother had a midwife at birth. As his father was a laborer earning 
$1.10 a day, the doctor's price was beyond their means, and no 
further medical advice was sought. Until 12 years of age he was 
dragged about in a cart by his younger brothers and sisters. About 
that time the family moved to Cleveland. A shoemaker in the 
neighborhood offered to make shoes for him which would enable him 
to walk. He also taught him to make his own shoes, which he does 
to this day. From that time he was no longer dependent, and, best 
of all, he could go to school, an unexpected but longed-for joy. Be- 



The Cripple and the Community 43 

cause the family income was so small, he felt after five years of 
schooling that he must go to work. During this time no suggestion 
of public hospital was made to him or to his parents by teacher or 
neighbors. Therefore, with practically no use of his hands, selling 
newspapers seemed the only opening. 

He is now 35 years old, and with the exception of a year when he 
tried the experiment of keeping a cigar store which was not a prof- 
itable business venture he has sold papers on a street corner. He 
has also some regular customers in office buildings. Both parents 
are dead and he is the support of a sister and two children, and two 
young sisters whom he hopes to send to high school. Very frankly 
he said: 

My parents were simple, ignorant people who did the best they knew how. 
I have no complaint to make. I am strong and vigorous. I like to work and 
am thankful for the opportunity because I must support my family. It is not 
too much of a care and it gives me something to be responsible for, and a reason 
to make a home. Think of the types of people with whom I come in contact; 
think of the side of life that has beeii revealed to me and from which I can guide 
my family. No, I have no complaint to make but I trust all cripples may have 
proper medical treatment; that they may have educational advantages; and 
that you may interpret us to the community, especially to employers. Both are 
strongly prejudiced and unwilUng to take us for what we are. 

This kind of occupation with no future to it would not be ad- 
visable for every cripple to follow, but no one watching this man at 
his work could doubt his businesslike attitude in close competition 
with the very alive young newsboys who frequent his corner. 

The results of this survey may seem so optimistic that one 
might easily assume that no further plans are necessary for cripples. 
But when it is known that one-half the total number were crippled 
in childhood, and that one-fourth of the total crippled population 
were under the age of 15 years at the time of the survey, very im- 
portant plans suggest themselves and are already under way in 
Cleveland. 

The importance of making such a survey cannot be overesti- 
mated either for Cleveland or other cities. It has not only given 
the interested groups and social workers in Cleveland a general 
knowledge of their crippled population in all its phases, but has 
also given them and others undisputable facts by which to judge 
this problem fairly. From now on mistaken ideas about cripples 



44 The Annals of the American Academy 

can be dropped. Here is an opportunity to put them right, so to 
speak, in the minds of their neighbors who are apt to have very- 
wrong ideas about the ambition, abiUty, and economic status of 
those who do not present the same outward appearance. From 
Cleveland, a city largely without industrial training either before or 
after disablement, where cripples unaided have contributed to their 
own successful economic independence, much can be learnt. The 
Uves of unknown cripples are much more normal than had been 
supposed, although, because of unequal chances, they have un- 
doubtedly often .followed the line of least resistance. 

The important fact to be faced is that cripples must be divided 
into two large classes, — the helpable by normal educational means 
and the helpable by specially devised means . By the former is meant 
those who are able physically and mentally to share normal oppor- 
tunities of life; by the latter is meant those who are unable physically 
and mentally to share normal opportunities of life and whom it is 
not human to force beyond their ability. They should be aided to 
live out their lives happily with the limited equipment they have. 
With this division it will be much simpler to estabhsh the normal 
place of the cripple in the community. To accomplish this means 
something more than case work with individuals; it means more 
surveys like Cleveland's'^ and educational campaigns, legislation, 
etc., as a basis for needed plans. 

What do the cripples themselves want? Turning again to the 
life stories of the successful ones, they want: 

1 — Not to be confused with the begging type of cripple. 
2 — Not to be forced into a special class. , 

3 — An opportunity to be judged by what is left and not by what is gone. 
4— To be given an opportunity to make the contiibution of which each is 
capable. 

5 — To share equally in all chances offered to normal individuals. 

This is the appeal from normal, thoughtful cripples to inter- 
ested individuals, organizations and social workers for an active 
share in life. The task then, is to extend permanently to all the 
advantages of community life. 



THE SICK 

By Edna G. Henry, 
Director, The Social Service Department of Indiana University. 

Social work, unlike medicine, still suffers lamentably from a 
want of precise and sufficient knowledge. More complete statistics 
upon poverty, pauperism and mere iliisery, their nature, extent and 
causes must be collected and made available before any social worker 
can speak with authority. Of two facts, however, he is already con- 
vinced. Prevention, and teaching for prevention, are as essential 
in social work as in medicine. Neither can there be any good social 
work without access to expert medical practice. This is true equally 
in the prevention of suffering or in its rehef, and true whether the 
concern is with mass betterment or with individual improvement. 
Whatever special line of activity occupies the worker, be it public 
or private, institutional or case work, the situation is the same. 

Lessons from the Medical Profession 

In seeking to remedy bad social conditions, they (the workers) have come to 
recognize more fidly the great handicap of bad physical conditions and have 
learned to welcome, in the effort to remedy these, the aid of a newer and more con- 
structive medical science. Their awakening is due, in part, to their own deepened 
experience of human need but even more is it due to the socialized members of the 
medical profession who have led the way in many departments of social endeavor .' 

Social workers today are a bit too proud of having socialized 
the physician. They feel that they have opened his eyes, so that he 
is aware nol only of the fact that a man's heart may not be treated 
without complete consciousness of the rest of his body but also of the 
additional truth that he cannot be considered or cured apart from 
the larger social unit of which he is a fraction. The condition of his 
lungs and legs may well be less impbrtant than his income or his 
wife's tastes and temperament. Any visiting nurse or social worker 
can name a dozen points the physician sees now which formerly 
were invisible to him. Physicians, upon the other hand, do not 
see, or are too busy to note, how social work has improved since it 

1 Mary E. Richmond, "Social Diagnosis," p. 204. 

4.5 



46 The Annals of the American Academy 

realized and admitted to itself its dependence upon medicine. If 
the social worker has learned nothing else from the medical pro- 
fession, there is at least the new value of records and more scientific 
method. 

Many will be inclined to deny that the value of any record has 
been enhanced by contact with doctors. They point with scorn, 
and alas, with truth, to the deficiencies of dispensary records. But 
medical work has made records more valued. For long the best 
social case workers have known that their records, and the use they 
made of them, in the end determined the quality of their work. 
They did not have to point to the obscure and forgotten careers of 
missionaries to prove that work, no matter how good, is lost and as if 
never done unless recorded. They regarded as sacred and confi- 
dential records which might embarrass individuals or ruin reputa- 
tions but when medical facts appeared on them, they learned that 
people's very lives and entire futures might depend upon a date and 
a diagnosis, or be lost through carelessness. It was then that records 
became as precious as babies. 

Unconsciously, too, workers now follow methods long con- 
sciously practiced and taught by physicians. It is not without signi- 
ficance that a bookf or social workers is called " Social Diagnosis," but 
only recently have students and new workers been called upon to test 
their labors with a medical outlme. It is beyond dispute that for 
social woes, the doctor's outline for physical ills should be followed. 
The order should never vary. ReUef of symptoms should always 
precede, but should be followed by diagnosis, prognosis, treatment, 
scientific research and public education for prevention. 

Even the most unthinking layman will agree to the necessity 
for any immediate relief of symptoms. No doctor will refuse to 
allay pain before he knows its cause. The trained social case worker 
must always have a plan which involves temporary relief first, with 
investigation afterwards. But this worker also, Uke the doctor, now 
demands diagnosis before further treatment. Some seek a prog- 
nosis also, although few are courageous enough to act upon it. 
Treatment, as with the physician, depends upon the individual 
worker, upon his knowledge and his acquaintance with reme- 
dies. Like most physicians, the majority of case workers stop at 
treatment and do not proceed to the further research and consequent 
possible public education for preventipn. 



The Sick 47 

Not only do the best methods of physician and social case 
■worker thus resemble each other; either to succeed must imitate the 
other in borrowing from all science and all available knowledge. 
The one may belong to the finest type of the recognized professions, 
and the other, as Abraham Flexner asserts, may be of none, but 
both of them must recognize their mutual need. A great painter, a 
violinist, or an aviator may accomplish his full purpose with naught 
but the technical knowledge needed for his own pursuit, certainly 
without all knowledge or without that charity the absence of which 
makes all wisdom as nothing. No physician and no social worker, 
however, any more than the mother of ten children, ever knew any- 
thing which at some time did not prove essential or invaluable. 

The social case worker must do more than imitate the physican 
in his method and in his tireless pursuit of learning. He must obtain 
from him also that technical medical knowledge which he alone 
possesses and the instruction and advice concerning its social appli- 
cation which he alone can give. 

Peesent Aims of Social Work 

Four centuries ago that ancient modern, Juan-Luis Vives, said : 
"It is not only those without money who are poor; but whoever 
lacks strength of body, or health, or capacity or judgment," and 
"a common peril besets the citizens from contact with disease. 
. . . . It is not the part of a wise government solicitous for the 
common weal, to leave so large a part of the community not only use- 
less but actually harmful not only to itself but to others." He also 
said, than which there has been no truer word written: "the law of 
nature does not allow that anything human should be foreign to man, 
but the grace of Christ, Hke fast glue, has cetnented all men 
together." 

Yet, after all these centuries, only three years ago, Dr. Richard 
C. Cabot was compelled to say, with truth, "We have dealt with 
man's estate extensively. We are now in the heyday of the dis- 
cussion of health of the body. We have just begun to see that the 
mind is the greatest of all questions for social workers. But that is 
for the future; we are still in the center of interest in health." He 
had to say also: "Health is still a separate section because it has not 
yet been welded into the whole thought of social workers." Cen- 
turies ago Montaigne declared that a man could not be divided for 



48 The Annals of the American Academy 

the purpose of educating him but apparently it is not yet clear that 
he cannot be divided for any purpose whatever, even by the most 
competent and well-intentioned social worker. 

Unfortunately, outside of the large cities, there not only is but 
little concern for health but too little provision for its maintenance. 
No social worker any longer listens with patience to the statement 
that the best comes from the country. So it does. Also the worst 
comes from the country — or the little town. Mark Twain possibly 
was right about its-origin. A country-born baby may have a better 
chance to be healthy, if he lives; but he and his mother have less 
chance to live. 

The social worker, hke the plain citizen, is not constantly aware 
that men's Uves and habits are determined by the ways in which 
they make their hving; and that the ways in which they make their 
Hving are decided all too often by their physical condition or by 
mental conditions growing out of disease. Only the rich, and the 
•poor of cities, may have adequate medical attention. This proposes 
to the social worker who knows it, all sorts of indi\adual health prob- 
lems and induces serious thought concerning the possible alterna- 
tives of social insurance and the complete pubUc control of health. 

Even ardent believers in democracy, in the equal chance for all, 
too often fail to see the necessity for primary physical fitness. Per- 
haps war will open some eyes. Men who beheve in the power of in- 
come discount health. Those who know that health is important 
agree with Benjamin Ide Wheeler and discredit the character-making 
possibihty of sickness rightly handled. But the social worker must 
deal with the whole man, his environment, his body and his mind 
and soul — his character. 

Necessary Medical Knowledge 

In trying to improve a client's enviroiunent, the social case 
worker needs to know something of neighborhoods, schools, the local 
housing problem, industries, the employment situation, the compara- 
tive chances in certain lines of labor for a Jew, an Irishman or a 
Swede, for men or women, hours, wages, and the best way to ap- 
proach an employer, actual or prospective. All social case workers 
know this but they do not all realize the same necessity for learning 
the prevalence of disease, the consequences of physical conditions, 
the character of the water and milk supplies, the existence and meeh- 



The Sick 49. 

anism of their medical institutions and the most effective manner of 
deahng with physicians and surgeons. Yet, where a few years ago 
foui -fifths of all the reference calls of the best known agencies were 
work references, today they are, or ought to be, medical references. 

But how, one may well ask, can a social case worker know his 
own business and medicine also? Is it fair to require so much and 
such varied knowledge? Is it possible to obtain it? No, and no 
again. Neither is it necessary to do so. The most serious mistake 
a social case worker can make is to appear to know anything about 
medicine. Nothing is so maddening to a physician oi so discourag- 
ing to the medical social worker as one who knows more about medi- 
cine than does the doctor. The inquiring social case worker who 
knows that an afternoon temperature always means tuberculosis, 
that osteopathy will cure epilepsy, that a patient with paranoia is 
"as smart as I am," that a skin eruption is syphilis and that syphilis 
at all times is a menace; a school nurse who herds in children for 
glasses and the removal of tonsils and adenoids — and nothing else; 
a city missionary who converts and protects girls but ignores theii 
sicknesses; — these are pests and regarded as such in any medical 
quarter. Equally obnoxious is the child welfare worker who cannot 
beUeve that a boy is feeble-minded; the relief agency which insists 
upon a positive diagnosis on a first visit; or the probation ofiicer 
who holds an epileptic responsible for all of his acts. 

Can these workers learn enough not to make such mistakes 
if they have no knowledge of medicine? They can. Social case 
workers need only to realize in the beginning that nothing will save 
the situation unless good medical service is available. If such serv- 
ice cannot be obtained, the social worker's first business should be 
to create an agitation which will result in the provision of doctors 
and nurses. If they are available already, or can be found, then 
the social workers must trust them. They must know their own job 
so well and engage in it for such fine motives that they can believe 
in the skill and sincerity of others. A social worker has a right to 
smile when a doctor says: "This man needs his rent paid"; and 
surely the doctor may smile when a social worker says: "This man 
has tuberculosis." The medical social worker learned long ago to 
say, not, "this man has heart trouble," but "This man complains 
of his heart. " 

Social workers need no knowledge leading to medical diagnosis 



50 The Annals of the American Academy 

or treatment. They should know, however, the causes and cost of 
those diseases which are social problems in themselves. They 
should know what these diseases are and why they entail a social 
burden. They should be concerned, not with disease, but with 
health. They should be able to recognize health and to learn what 
there is in the community which will maintain it for all. 

It is not necessary for anyone but the doctor to recognize or to 
treat tuberculosis but many in addition should know that tuber- 
culosis costs the community more in money and in sorrow than does 
any other one disease; The value of early diagnosis should be 
known and, for the individual case, what has been advised medically. 
A social case worker does not have to decide whether or not a patient 
needs hospital care but should know what hospital facilities there 
are and what will happen to the home of the patient should he leave 
it. No social agency has to conduct a hospital, oaly to know how 
hospitals are conducted, or, if there are none, how to get or reach 
them. It is still more worth while to create, in any commimity, 
sdch health as will decrease the demand for hospitals. In other 
words, social work must recognize the character and extent of dis- 
ease, its own dependence upon the physician and the possibility of 
full cooperation with him. It must not encroach upon his territory 
or permit him to dictate unwisely outside of it. 

Purpose of the Federal Childrex's Bureau 

The three times in a man's life when the social worker can ac- 
complish most for him are the same periods at which the physician 
can do the most also. These are when he is a babj' — with his mother 
— when he enters school and when industry claims him. It was 
Bernard Shaw who said that if the world and its affairs were as they 
should be, a man would need a doctor but once in his life, and that 
for his mother, when he was born. This is so true as to be tragic 
when the truth of it is ignored. Could every mother have proper 
prenatal care, inspection (for, after all, birth is not disease), instruc- 
tion, confinement care, nurse and physician, the health problem 
would be more than half solved. In America, 300,000 children 
under five years of age die each year. Over half of them need not 
die. This is a waste of life, of vital energy, of time, and a cause of 
needless suffering which the country is no longer willing calmly to 
tolerate. The Children's Bureau proposes to save these babies 
through individual effort, by: 



The Sick 51 

1. Registration of births. 

2. Complete care, nursing and medical, for every mother, whether she can 

afford it herself or not. 

3. Children's conferences and clinics. 

4. Organization of local bureaus of child hygiene. 

5. Pure milk. 

6. Adequate incomes. 

The Children's Bureau was born of the child labor movement 
and fathered by the Department of Labor. Why has it deserted 
its own field, to enter that of health? It has not. This is but a 
logical step from its inception to the attainment of its owft purposes. 
It looked into its own questions, made some research, and has turned 
to the right beginning, to the babies, and to public education for 
prevention of ill to them. Immediately, it finds itself leaning upon 
the doctor, the public health man, for instruction and guidance and 
upon the workers in each locality to look after each individual baby 
and, in the process, to educate the mothers. Nothing so clearly 
illustrates the circle around which one travels for the maintenance 
of health, the perfecting of industry and the consequent betterment 
of living. There has been enough of vicious circles. This golden 
one is to succeed them. 

The Social Worker and the Health Problem 

When the social workers, however, reach health problems, they 
( come to them in many ways. There are workers within institutions, 
workers in the community, workers concerned with morals, with 
education, with relief, with health and those whose whole business is 
with sickness itself. The chief object of the workers necessarily 
modi^es the manner of attacking the health problem. 

The social worker should define clearly to himself his own job, 
realize in precisely what way health is necessary to its successful 
accomplishment and act accordingly. The worker in an institution 
should know that he or she has an opportunity to get everyone in the 
house thoroughly examined and treated and consequently may 
perhaps send them out in better health than they otherwise ever 
could have had. This is his business. A girls' school which does 
not examine all sent in for immorality, a prison which fails to learn 
who is feeble-minded, who is insane and who tuberculous, is a curse, 
not a safeguard, for its people. An orphans' home which ignores 
the physical condition of any child is unfair to all of them. A jail 



52 The Annals op the American Academy 

usually is more dangerous than any mediaeval plague spot. But the 
whole business of a social worker in an institution is to see that his 
charges are placed in the hands of a good doctor and to enforce 
that doctor's orders when given. He needs to know, not medicine, 
but the comparative value of health and the social destructiveness 
of disease. 

For the attendance oflficer, the charity organization agent, or 
the children's worker in the community, the affair is not so simple. 
In a large city where there are well-known and excellent dispensaries 
and hospitals with social service departments, all the worker has to 
do is to learn their location, mechanism and peculiarities. After 
that, the word of the medical social worker in the medical institu- 
tion may be sufficient. In the smaller commimity, the affair is more 
serious. An attendance officer who is now a medical social service 
worker was asked where she got her first medical experience. She 
said that she had obtained it when a truant officer in a village. 
Then she had had to learn, not how to enforce a compulsory school 
law, but how to rid her clients of vermin and how to distinguish 
impetigo for cancer. She had learned further that it was easy to 
find doctors, to ascertain their hours and the extent to which she 
coidd impose upon them. Such imposition is justifiable and neces- 
sary as yet and the doctors have never complained, but social 
workers certainly should reaUze, whether anyone else does or not, 
how much free service the average physician gives, and how desirable 
some better and fairer methods is than the one now in use. Outside 
of the institution the social case worker then needs to know thor- 
oughly all of the medical and nursing resources of the community 
and how to use them with the least trouble to busy doctors and 
nurses and with the maximum results for his own people. 

A social case worker should also try to inform himself concerning 
some of the simpler questions of hygiene and the common and best 
known facts about disease. There is no doubt that, other things 
being equal, the worker today who has had some experience or train- 
ing in a medical social service department is more valuable than any 
other for any variety of case work. This is not because he has learned 
medicine but because he has come to know how to use the medical 
knowledge which is available and has acquired something of the 
medical point of view toward the patient. 

"Social workers have been handicapped even in their use of 



The Sick 53 

these sources of information by their lack of knowledge of even the 
most elementary facts of disease and by their lack also of under- 
standing of the organization and discipline necessary in a hospital 
or dispensary."^ Moreover, the organization and discipline to 
■which a good medical social worker yields is in itself training too 
often denied the average social worker who, to be effective, is neces- 
sarily something of a free lance. A student who has had to observe 
dispensary rules and to remember that every one is sick, never makes 
the stupid blunders about health and doctors of which other workers 
are certain to be guilty, although he may make worse. The medical 
worker is always as much interested in incomes, housing and occupa- 
tion, as is the relief agent ; but the latter is not always equally con- 
cerned about health questions. 

More and more, therefore, where it is possible, general social 
workers are acting more closely with nurses and the medical social 
workers in hospitals and dispensaries. It is easier and more effective 
thus to divide the job. Perhaps the greatest concern of any worker 
in the community should be to see that there are enough and the 
right sort of medical institutions properly equipped with medical 
social workers, while most certainly the chief concern of all should be 
that prevention of disease which alone will decrease the necessity 
for so much medical care. 

Objection is made to such cooperation. It is claimed that the 
visiting nurse is too often blind to social and relief situations and 
most untaught in social procedure. She will ask for eggs without 
number, no matter what the price. Worse, she may insist wrongly 
upon unwise aid for a sick woman whose husband has deserted her. 
Upon the other hand, it is the nurse alone who knows efficient, and 
therefore economic, forms of relief for the sick and she may be the 
first to discover some sorts of illuminating information never given 
to any but doctors or nurses. 

Objection is made further that the necessity for such coopera- 
tion works for harm because it sends too many people into one 
family. The layman is always aroused by such so-called duplica- 
tion of work and the intrusion upon the individual's privacy. To 
be sure, until the war is over, less will be heard about intrusion upon 
privacy. As for sending too many people into one family, it is well 
to remember the answer of a certain Boston worker when the ques- 
' Mary E. Richmond, "Social Diagnosis," p. 255. 



54 The Annals of the Ambeican Academy 

tion of referring unmarried mothers to other agencies was dis- 
cussed. She alone thought it all right to transfer such a patient and 
added, "You only give her another friend." That is the point. 
The relief worker who tells a client who is going to the dispensary as 

a patient to be sure and see Miss B , the social worker^^ makes 

another frignd for a woman who has too few acquaintances wiser 
than herself. This has a further point, if it is remembered that in 
the final analysis the social worker can justify his existence in but two 
ways, by what he can teach and by what social chasms he can bridge. 

The Social Worker as Teacher 

What any single worker can do for an individual person, all 
that he can accomplish in one long day, will never prove his value 
unless he also is always a teacher, and one who remembers that the 
best teaching is by example. The social worker is the modern neigh- 
bor. He must not only be a teacher but at all times an additional 
connecting link between the normal and the abnormal, between the 
fortunate and the unfortunate in a world which grows too complex 
for most. It is, therefore, an advantage to specialize in social work as 
well as in any other profession. The client may have as many friends 
as he has varieties of troubles and each will make an additional 
link in the chain which binds him to a better part of the commimif y 
which he represents. Such a social worker, primarily concerned 
with other than health problems, needs only to remember the value 
of health, its relation to his own questions, to recognize its absence, 
to know where to go for it and how to obtain the nurses and medical 
social workers as well as doctors who are needed for the maintenance 
of health and the prevention of disease in his community. 

■ A very just objection to this attitude is the fact that it cannot 
apply to rural communities. These force upon the social worker, 
even one interested only in sick individuals, not only local problems 
of nursing and medical attention but the larger ones of education for 
health and public control. Such a violent departure from the pres- 
ent situation may well arise from agitation in long neglected country 
districts. 

The medical social worker has a certain value another has not, 
both for health problems and for social problems connected with 
them. From the doctor she' learns what social relief must be added 

' " She " rather than " he" is here used in referring to the medical social worker 
as in the vast majority of cases if not universally, such workers are women. 



The Sick 55 

to medicine for the alleviation of physicial pain; she knows not only 
the medical diagnosis but in how far the social diagnosis depends 
upon the condition of the patient's body. She is better able to say 
what the social prognosis will be for a sick man; and she certainly 
can give not only to other workers but also to legislators and even 
to doctors, illustrative arguments for new social laws and procedures. 
Not only that, she sends her patients out to teach health even as other 
social workers send theirs out to teach facts about labor, housing 
and community life. If one good housekeeper in a city block may 
teach ten, the woman who has all of the babies "measured" is the 
one who should be converted to the use of pure milk. 

The medical social worker was born not only of the public's 
increased desire to alleviate misery, to make medical work more 
effective or to teach for prevention rather than to relieve. She 
came into existence primarily as a "logical result of the recent ad- 
vance in medicine."* No better explanation can be given than to 
continue : 

The social service department has a still higher office .... namely, 
the aggressive campaign toward the prevention of disease. The recent advance 
in medicine shows that nearly all of the most serious conditions are easily curable 
if treated early enough, while many others are more easily prevented than cured 
. . . . and since the most important cause of social dependency is sickness, 
those charitable organizations whose function it is to relieve conditions of poverty, 
see in hospital social service an agency which in time will lighten their burdens, 
although in the beginning it may appear to increase them. Indeed it may be said 
with confidence that social service departments in connection with our busy hos- 
pitals and dispensaries will in the future be the most potent means for the pre- 
vention o£-disease, and, therefore, of the miseries which so often are the result of 
disease. 

The medical social worker differs from other social workers 
only in that she deals with sick people, 'and that, unlike all others, 
she is always found within, if not as an integral part of, another 
institution, a medical institution. A man may be poor or immoral 
or a woman may be in distress but unless there is also physical suffer- 
ing their care is no more the concern of a medical social service 
worker than of a church or of a reUef agency. Moreover, they 
come to the attention of the social worker within the institution of 
which she is a part and haye themselves sought that institution, and 

* Charles P. Emerson, "Social Service and Medicine,'' Report of the Social 
Service Department, Indiana University, 1911-1912. 



56 The Annals of the American Academy 

consequently the worker, first. This worker extends into the sur- 
roundings of the institution the ever widening circumference of its 
influence, instead of attacking similar problems in the community 
itself. 

The Point of Attack 

Like charity organizations and the church, a medical social 
service department concerns itseK with the whole man but its point 
of approach and the method of attack are different from that of 
either. The primary business of the medical worker is with the 
cure or relief of disease but to obtain her results she must consider 
character quite as carefully and sacredly as does the church; prize 
education as does a school; join public health movements and daily 
distress herself with problems of relief. While medical social serv- 
ice is one, and the most recent, manifestation of the growing public 
health movement, and is a part of the pubUc demand for the aboli- 
tion of poverty and the decrease of all needless suffering, it must 
never be forgotten that, above all, it is the latest outgrowth of mod- 
ern medicine. Today, therefore, advancing social work of any sort 
must be Hnked with scientific medical work. The hospital and the 
dispensary which cannot give a high type of medical service should 
waste no time on social service. The social worker in a community 
which offers no fine medical service is wasting most of her time and 
money. If communities are to deal with the social problems which 
have been in their midst for centuries but are being revealed slowly 
by city life or swiftly brought under the limeUght by war, these com- 
munities must have trained social workers, conscious of the value of 
health as well as of economic and spiritual good, and must also have 
splendid medical work. 

What Problems Are Most Important 

In this connection it may be interesting to note what social 
problems loom large to the medical social workers. One department 
furnishes a list of the social ills which have come most often to its 
attention and have made for it 1>he most work or the most anxiety. 
These are: alcoholism, babies born in hospitals, broken families, 
cardiac troubles, cripples, children, drug habitu6s, epilepsy, eye 
troubles, feeble-raindedness, foreigners, gonorrhea, illegitimacy, 
industrial accidents, diseases and maladjustments, sick inmates of 



The Sick 57 

state institutions, insanity, negroes, sex problems, suicide, syphilis, 
tuberculosis, unmarried mothers and vagrants. This classification of 
social ills, most of them recognized only as diseases, is peculiarly 
worthy of note at a time when the government and the Red Cross 
also are trying to maintain health and social equilibrium. A certain 
army surgeon lately stated that in his opinion the greatest problems 
after thewarwould be: broken families, crippled soldiers, tuberculosis,' 
mental and nervous complications, heart disease and venereal dis- 
eases. The social service department which offered the above list 
had found to its astonishment that its greatest problem was the 
broken family. It had more broken families than any other one 
trouble.. Next to broken families and children, it was most con- 
cerned about cardiac patients, mental and nervous cases, and after 
them, the tuberculous and syphilitic. In other words, the war will 
create no new problems for social workers, but will only reveal or 
emphasize those already existing, especially those of death and 
disease. 

Social workers who are in the habit of thinking of their social 
problems in other terms, economic, moral or mental, should notice 
how closely their ills are interwoven with these medico-social ques- 
tions. It is worth while also to see which of these have been aban- 
doned by the case worker. No social worker any longer believes 
that the time and money spent in an effort to reform a single drunk- 
ard are spent most worthily. She wants to see prohibition tried. 
There is no medical social worker who is not ready to ask for the 
public control of venereal disease, and for more institutional care 
for the feeble-miinded, insane and epileptic. Because of the tragic 
cardiacs and the tuberculous she cries aloud for prevention and 
education rather than cure. The proved decrease of blindness, 
with the increase of eye troubles which keep children from school 
and impair the efficiency of workers, even more illustrate the crimi- 
nality of indifference to prevention. 

It has been said that every patient who enters the door of a 
dispensary is a social problem. Thus far, this is true. It is equally 
true that all social problems involve questions of health. Some day 
the public will be as impatient with people who are not well, who are 
not able-bodied for their jobs, as it is now with the man who cannot 
reach work Monday on account of Saturday's drink. 

All social workers must take more and more into consideration 



58 The Annals of the American Academy 

the problems of health, both for the individual and for his com- 
munity, while the medical social worker should study more and 
more the larger social questions. If no social worker can know too 
much, no medical social worker ever knew half enough. In the 
beginning it was thought that such a worker must be a nurse. In 
some cities she still must be. Nevertheless, it is an admitted fact 
pointed out even by their leaders, that the nurses who make good 
social workers do so, not because they are nurses, but because they 
have ability in another profession as well. Social work, even medi- 
cal social work, is not nursing. The average nurse, moreover, lacks 
general knowledge of people and affairs and is less likely to have the 
necessary broad education. Not only that, her training tends to 
close her eyes and dull her natural initiative; whereas, a social 
worker, if she succeeds, must have and use science, imagination, 
daring and ingenuity. As yet, she is most often a woman, and all 
• of the .qualities which a great mother or a successful teacher needs 
should be hers. For the patient's sake she should have imagina- 
tion, sympathy and good judgment. She should be just, as well as 
kind. For he' own sake she should have good sense, good health, 
wholesomeness of spirit, a sense of humor and unconquerable faith 
in folks. She should have a true knowledge of the texture of normal 
society, of modern social problems, of the inter-relation of depend- 
ence and disease. She should know humanity, out of her own ex- 
perience with it or her behef in One who knew. "He looked out 
from his Cross upon a jeering multitude, sjonbol of the vaster multi- 
tude who forever jeer and crucify the good, and there He performed 
His supreme miracle. He believed in them. He saw what was in 
them." 5 

Such a worker will never be blind to, nor lose sight of, any of 
the ills of her client or patient; never fail to seek the underlying 
cause of his trouble, either in his own life or in the society of which 
he is a part. She will never fail to seek medical care or advice for 
all who need it. But she also will advise and urge more education 
concerning health, more frequent routine examinations of babies, 
school children and workers. She will insist upon measures to 
lessen the state's vast expenditure for social wreckage due to disease 
and to increase those for the promotion of universal health. Such 

• William Lowe Bryan, "He Knew What Was in Man." Indianapolis: 
The BobbB-Merrill Company, 1913. 



The Sick 59 

a worker will argue with wisdom concerning the just expenditure of 
effort and money and the possibility of success with the individual 
case, or, in losing it, will be comforted by the use of it as educative 
material which may serve to save others from similar fates. Any 
social worker who would obtain the greatest result, socially or 
medically, must forget himself in the pursuit of good for his client. 
He will get for him all that he can of income, health and happiness; 
but he will never forget that what he does or fails to do, if recorded, 
will add to human knowledge and echo to the end of time. 



PRINCIPLES OF CASE WORK WITH THE FEEBLE-MINDED 

By Catherine Bbannick, M.D., 
Psychologist, Massachusetts Reformatory for Women. 

The subject of feeble-mindedness is now recognized as one of 
the most important educational and social problems of the day be- 
cause of its relation to other social problems. Various researches 
have shown that it complicates practically every one of our social 
questions, poverty and dependence, delinquency, vice and crime, 
inebriety, vagrancy, unemployment and industrial inefficiency. 
Numbers and relative increase are the important factors in the prob- 
lem: it is estimated that three in every one thousand individuals in 
the United States are feeble-minded, making a total on this basis 
of 275,000; in proportion to their population they are increasing at 
practically twice the rate of the normal population. The burden is 
heaviest in the fields of delinquency and crime: 48,000 feeble- 
minded persons are committed yearly to correctional institutions in 
the United States, and the percentage of feeble-minded within these 
institutions is variously estimated from 15 per cent to 50 per cent. 

As research has demonstrated the widespread significance of 
the problem, methods of meeting it have multiplied, with the idea 
of prevention leading. At present thirty-two states make some 
provision for this group in special institutions. In many cities 
special classes have been established under the pubhc school system 
providing a curriculum adapted to their needs. A few states 
have passed permissive laws providing for sterilization and in 
effect debarring marriage under certain conditions. The depart- 
ment of immigration has recognized the problem by more careful 
examination and observation of the immigrant. An educational 
campaign has been directed by numerous organizations throughout 
the country interested in eugenics and mental hygiene and a special 
committee, national in scope, was organized in 1915 with objects "to 
disseminate knowledge concerning the extent and menace of feeble- 
mindedness and to suggest and initiate methods for its control and 
ultimate eradication from the American people." 

All forms of treatment revolve about the special institution for 

60 



Case Work with the Feeble-minded 61 

training and segregation, but it has come to be accepted that it is 
impracticable and even undesirable to work for such provision for 
all members of the group. There can be no question but that in- 
stitutional treatment is the most economical and the only rational 
one in the case of the low grade, the intractable and the clearly un- 
protected. On the other hand, it is quite as evident that given 
proper personal and social treatment, many more of the group will 
be safe and fairly useful members of the community. These two 
ideas, segregation Umited or permanent, and special training with 
directed oversight in the community, are the guiding principles of 
the plan of treatment outlined by the mature and progressive stu- 
dents of the problem. In Massachusetts, which already leads in its 
provision for the feeble-minded, a state program has been outlined 
by the League for Preventive Work which methodizes these ideas. 
The program, known as the Fernald plan, provides care for the 
known defectives according to their individual needs and methods 
of finding others. It includes: 

(1) A state commission 

(a) for friendly guidance of mental defectives who under supervision 

can live wholesome lives in the community, 

(b) with authority to safeguard in a state school those who cannot. 

(2) A state-wide census of the uncared-for feeble-minded 

(3) Clinics for mental examination easy to reach from all parts of the state 

(4) Special classes in public schools for mentally defective children 

(5) Special treatment by the courts of mentally defective delinquents 

(6) Completion of a third school for the feeble-minded 

In addition, the State Board of Education is "planning a State- 
wide investigation to determine the number of subnormal children 
not being provided for in institutions," with the idea of formulating 
a state-wide pohcy for the special training of these children. It is 
hardly probable that such a model plan can soon be carried out in 
its entirety even in the most progressive states. Certain of its most 
important principles can be tried out, however, even in those states 
which are most backward in providing for the feeble-minded and 
chief of these is the principle of individualization of treatment. 

The idea of applying this principle to work with mental de- 
fectives is new and as yet not very acceptable to the general social 
worker. In the words of one of these workers, "there's no such 
animal as case work with the feeble-minded." The assumption has 



62 The Annals op the American Academy 

been that once an individual has been diagnosed as mentally defec- 
tive, there is nothing more to be done unless he can be shut up in an 
institution. This attitude disregards the facts that variations and 
types of mental defectives are as many as among the normal; that 
many who must be graded as mentally defective are in a limited 
degree socially competent, are making a poor but adequate living, 
and so have escaped the attention of the social agencies; that social 
incompetence or inability to manage one's own affairs as used in the 
definition of feeble-mindedness may be modified by special training 
and oversight. 

Recent figures of psychological tests given to the drafted men 
of the United States Army show that approximately 2 per cent of 
the men are mentally inferidT. Their services, nevertheless, are to 
be used within the army in forms of work suited to their intelhgence, 
— in the care of horses, carting, road repairing, etc. The inference is 
that there had been no expression of social deficiency, to any degree, 
in these men previously. 

Feeble-mindedness is best defined as "social incompetence due 
to arrested mental development." It is therefore more inclusive 
than the term "mentally defective" and is used in a double sense, — a 
psychological and a social one. It does not imply an absolute lack 
of possibility for social competence, but only a limited or relative 
one. The definition of the British Royal Commission (1908) 
specifically defines an individual of the highest grade of feeble- 
mindedness as one "capable of earning a living under favorable 
circumstances, but incapable from mental defect existing from birth 
or from an early age of competing on equal terms with his normal 
fellows, or of managing himself and his affairs with ordinary pru- 
dence." In practice, the two aspects of feeble-mindedness, defec- 
tive intelhgence and social deficiency, are found combined in vary- 
ing degrees. Many of the relatively low grades of intellectual de- 
fect show no special anomaly of temperament and disposition and 
grade fairly high by the social test; many others who grade rela- 
tively high in the psychological sense show such temperamental 
eccentricities as to make social adjustment impossible. 

Although constructive work with the feeble-minded outside of 
institutions is as yet comparatively new and undeveloped, it has 
already demonstrated the possibilities of modifying the social in- 
efficiency in certain types so that they are acceptable and fairly 



Case Work with the Feeble-minded 63 

useful members of society. Classes for subnormal children in 
Springfield, Massachusetts, in Boston, New York and other cities 
not only have given specialized education and training, but through 
the personal interest of the teachers or specially appointed visitors 
from the schools, the children have been followed into their working 
life and the necessary help and supervision given in industrial 
adjustments. 

It is well to dwell on the hopeful and positive aspects of individ- 
ual treatment of this group for, whether the eugenist arid social 
reformer will or no, the feeble-minded will still remain in the 
community. In Massachusetts, the leading state in institutional 
provision for the feeble-minded, there are as yet only one-fifth of 
the estimated number in the state so cared for. 

Since institutional care for all of the group is obviously out of 
the question, the next consideration is the classification of types to 
fit the two main divisions of treatment, institutional and com- 
munity. This classification would be based on considerations 
covering in general the personal and social factors in the make-up 
and immediate surroundings of the individual, as : 

(a) Age 

(b) Degree of mental defect 

(c) Inherent and innate characteristics other than the purely intellectual 

(d) Possibilities for special training in the community 

(e) Possibilities for protection and supervision 

(f) Development or no of anti-social habits 

Feeble-minded women who have passed the active sexual 
period and show no special emotional irregularities should be able 
to fit into community life under supervision. Men with no anti- 
social tendencies are often found self-supporting and fairly useful 
workers in many of the lower forms of industry. These are the 
men so often described by their employers as "honest, faithful and 
industrious, but not over bright." Very young children should not 
be allowed to crowd the institutions for the feeble-minded, to the 
neglect of more urgent and suitable cases. Frequently parents ask 
for the comnaitment of such children to be rid of their care, and 
social workers are often found aiding or encouraging this, though 
the case may present no special problem in itself nor even in its rela- 
tion to the family problem. 

It is of course self-evident that the lowest grades of mental 



64 The Annals of the American Academy 

defectives, even young children, unless physically and socially well 
cared for, should be in institutions. This is the type which fits very 
fairly into other institutions than the special ones for defectives. 
Above these grades, the decision as to the form of treatment wiU 
be based more largely on the temperament and disposition of the 
feeble-minded individual than on the degree of purely intellectual 
defect. Even when the community offers good opportunity for 
special training, the decision between institutional and community 
care will still depend on the individual, on the probabihties that he 
can be made industrially and socially efficient to some degree. Is 
there possibility of adequate protection and supervision? Has he 
the physical capacity to get on outside an institution? Are his in- 
nate tendencies such that he is unlikely ever to fit into community 
life? Is he lazy, cruel to his weaker companions, sexually over- 
active? Is he innately irritable, stubborn, destructive and abusive 
in temper? Is he untruthful, sly or thieving? If these or other 
innate tendencies that have an anti-social bearing are present in the 
feeble-minded, then institutional treatment is the choice, irrespec- 
tive of degree of mental defect, or sppcial ability along industrial 
lines, or opportunity for training in the community. 

Any industrial or reform school can give plenty of evidence 
that it is not the intellectually higher types that should be kept out 
of institutions for the feeble-minded. The directors of these schools 
complain that most of their troubles of a disciplinarA- nature can be 
traced to these defectives, and one director goes so far as to say that 
there is no incorrigible prisoner in his reformatory who is not sub- 
normal. 

As found on commitment, there is no doubt but that the ma- 
jority of these defective dehnquents are troublesome beings, but 
there is always the question whether a certain number might not 
have been improved to the point of relatively fair social competence 
by individual treatment in the community earlier When a feeble- 
minded boy or girl is recognized as such for the first time in a reform 
school, it is sometimes difficult to separate innate chai-acteristics 
from acquired bad habits and influence of environment. Mental 
dfefect and mental instability frequently are present in tlie same 
individual, but the instability observed in the adult feeble-minded 
is undoubtedly due in some instances to environmental over-stimula- 
tion acting on defective inhibitory powers. This is illustrated in 



Case Work with the Feeble-minded 65 

reformatory experience the opposite of that of the superintendent's 
described above, and it sometimes happens that a feeble-minded 
individual, whose conduct in the community kept his relatives and 
the police busy, gives no trouble when under restraint in an even 
environment. 

The classification of defectives for the purpose of outlining 
treatment should form a part of the diagnosis in every case, and for 
this reason is work for the expert, capable of giving clinical considera- 
tion to all the characteristics of the individual, physical, mental and 
temperamental, and of evaluating them in their relation to his en- 
vironment. A simple diagnosis without recommendation is not 
much more helpful in the fields of psychology and psychiatry than 
in the field of general medicine. Any one who has had to deal with 
problems of delinquency or other forms of conduct disturbance, 
knows that when the psychologist has said that an individual is or 
is not feeble-minded, he has said the least that can be said. If the 
person is feeble-minded, the conduct disturbance may or may not 
be directly related to the mental defect, while the bald statement 
that he is not feeble-minded leaves his conduct disturbance wholly 
unexplained. An interpretation of the individual is the only help- 
ful diagnosis and is as important in the case of the feeble-minded as 
with the intellectually normal who present behavioristic problems. 

Such interpretation is absolutely essential to the inteUigent 
handling and oversight of the feeble-minded in the community. The 
outlook at best may not be encouraging but the problem is there 
and must be met. All too frequently it happens that the institu- 
tion is non-existent and that the community form of treatment is 
the only possible one. When one knows the individual, that he is 
defective to a stated degree, that his defect is or is not transmissible, 
that he has certain socially favorable characteristics that must be 
deliberately fostered or socially negative tendencies that must be 
deliberately repressed, it is possible to work with hope that is not 
overhopeful. 

In the handling of feeble-minded children in the community, 
one can do no better than borrow from the principles and methods 
of the special institutions and classes that have already been suc- 
cessful with them. The most successful of these appear to have 
applied education to defective children in its hteral sense, a "draw- 
ing out" what is in the child more than a "pouring in," irrespective 



66 The Annals op the American Academy 

of ability to hold or digest, as seems to be the interpretation of edu- 
cation in the ordinary school. They search out special aptitudes 
and develop them; tl^ey deliberately take advantage of the strongly 
imitative and suggestible qualities, and exercise these qualities for 
good; in the absence of any ability. on their own part to build up a 
true morality, the children are given a superficial morality by pun- 
ishment or deprivation when they do wrong, and reward or praise 
when they do right. 

If the child is in the regular graded school room, it is very neces- 
sary to watch lest he be given tasks that are quite beyond him and 
pushed to the point of mental irritability. The knowledge acquired 
in school is much less important than the habits formed and the atti- 
tude toward life and work. A habit of failure acquired in school is 
as bad for the ieeble-minded child as for the dull normal, and quite 
as often follows the child into his working life. If he is the type of 
defective who has insight into his own dulness, the habit of failure 
may be accompanied by a discouragement which is very difficult to 
overcome. 

Two excellent examples of individual work with feeble-minded 
children in the community were observed by the writer in connection 
with work in an open air school, having two teachers for fifty pupils, 
and a resident nurse. One of these was a girl of thirteen and a half 
years who had been in the school for three years and in that time had 
completed only one grade. Physical examination on entrance and 
at the time observed showed nothing more than poor general condir 
tion. At the time of observation she had been promoted to the 
fiftli grade, but was not by any means doing the work of that grade. 
By all forms of psychological tests she graded as feeble-minded, 
passing just over nine years by the Binet (1911) scale. The teach- 
er's report was that she was abnormallj' quiet and reticent when she 
entered the school, but a likeable girl on the whole. Her dulness 
had been recognized, and she herself seemed quite as conscious of it 
as the teachers. The school's efforts to overcome her reticence 
showed excellent results in the girl's general attitude, though she 
was still very sensitive to her dulness. Some fear was felt when she 
left school at fourteen that her old reticence might make it difficult 
or impossible for her to fit into industrial life, but she found factory 
work at seven dollars a week and still kept the work when last heard 
from eight months later. 



Case Work with the Feeble-minded 67 

The other pupil was a girl about whose age there was some 
fioubt, — the school giving her age as thirteen and a half- and her 
mother as fourteen and a half. This girl was recommended to the 
open au" school primarily as a conduct problem, although the groiinds 
for admission were present in the very poor general physical con- 
dition. The history as given was that she had been growing more 
and more troublesome for a year past, and recently had become 
quite incorrigible in the class room. She would thrust her tongue 
out at the teacher, make faces at the other pupils, etc. The prin- 
cipal referring the girl thought it a case of beginning psychosis. She 
was in the fifth grade. An older brother had also been very trouble- 
some during his last year at school, in the fifth grade, and had been 
transferred to the industrial room. 

Psychological examination showed an unmistakably feeble- 
minded girl, mental age by the Binet scale being less than nine years. 
When first admitted to the open air school she reacted in the class 
room as in the previous school, and gave considerable trouble even 
in the recess and rest periods. After two weeks trial, it was decided 
to take her out of the class room, but to let her remain in the school, 
taking her rest periods with the other pupils and helping the school 
matron dming her class periods. Her improvement was so marked 
that the consent of the principal was asked for the continuance of 
the plan. There was no further conduct disturbance though she 
continued to be noisy and boisterous in play for the first few months. 
She remained for that school year, her only school work in that time 
being selected reading. On leaving school she found work in a 
factory at $7 . 50 a week and was at the same work when last heard 
from eight months later. 

The home as a factor in the training of a feeble.-minded child is 
of course even more important than the school. Where the home 
is not in itself capable of giving adequate oversight, the assent and 
cooperation of the parents are manifestly necessary for supervision 
from the outside. Under authorized supervision from a central 
state agency, the question of cooperation would probably never 
arise, even though the actual visiting were delegated to local private 
agencies. It is unlikely, however, to arise in the case of any home 
that is capable of properly training and protecting a feeble-minded 
child. With the children themselves there is rarely any difficulty 
in approach, — they do not question motives as the normal child. 



68 The Annals op the American Academy 

The parents should be told very frankly any special points in 
the diagnosis and recommendation and be given specific instructions 
from time to time as to methods of handling the child. Especially 
should they be warned of the necessity for the formation of regular 
habits and the dangers of overstimulation. Ways of fostering the 
socially positive qualities of the child and combating the negative 
qualities should be gone over in "words of one syllable," if need be. 
All work should be directed to the formation of good habits and the 
avoidance of bad. 

Ways of keeping the child's interest in the home should be 
devised; a habit of reading should be encouraged and books selected 
for their possibilities of pointing a simple moral without any special 
stimulation; simple games that give the child a fair chance to win 
should be provided from outside if the family cannot provide them. 
Any musical ability or interest of the child should be fostered. 

While the child is still in school the question of the kind of work 
he is likely to do later should be considered. It is well to plan for 
this as near the home as possible to avoid the expense of carfares 
and the many undersirable distractions that car-riding involves. 
Lack of ability to do certain forms of work does not handicap the 
feeble-minded so much as lack of ability to attend to the job. For 
the child who has been deliberately trained to a fair degree of stick- 
to-itiveness, this will be much less of a handicap and he should fit 
very fairly into many forms of unskilled factory work. 

Possible employers should be interviewed and interested in the 
practicabiUty of employing such children. Their response is often 
surprising. They take the rather sensible stand that it is as well to 
employ people about whom the worst is known as to run the chance 
of getting the same people through the regular employing channels 
and know nothing of them. One of the most encouraging and 
heartening experiences that come to the tired social worker is the 
encounter with the kindly employer or foreman who says he is will- 
ing to give the defective child a chance and who gives much more 
than a chance; the effect of his friendly supervision is shown later 
in his confidential opinion that the doctor who said that particular 
child was feeble-minded doesn't know his business. This kind of 
an employer and especially this kind of a foreman is really not an 
isolated instance. 

A point to be especially emphasized in work suitable for the 



Case Work with the Feeble-minded 69 

feeble-minded is the possibility for supervision. The best and most 
complete special training can never make of the defective anything 
but a helper. There is no exception here even in the case of those 
defectives who have special abilities along certain lines, for although 
they may be able to do the actual work done by a carpenter or a 
plumber, they cannot plan as a carpenter or a plumber, or work 
independently. 

Both social, workers who give supervision and even more the 
families of the feeble-minded persons are apt to forget that a fair 
amount of recreation is as necesary for the defective as for the nor- 
mal, and that it is quite natural that he should desire the particular 
forms of recreation the rest of the community enjoy. Games in the 
home, music, reading, fancy work, are not sufficient when all the rest 
of the world, including other members of his own family, are attend- 
ing moving pictures or a band concert. Outside recreation should 
be planned for in a degree which does not cause overstimulation, and 
under supervision which is not so obvious as to arouse antagonism. 

In dealing with the adult feeble-minded individual who has been 
recognized as such for the first time as an adult, one realizes that the 
most important part of the program of work for the feeble-minded 
is the provision for methods of early diagnosis. As found, he pre- 
sents a problem of mental defect with all that it implies of lack of 
judgment and control plus well estabUshed habits that are difficult or 
impossible to break. If these habits happen to be actively anti- 
social we have what is so popularly known as .the defective dehn- 
quent. Treatment of this type outside an institution is practically 
Hfever successful and institution directors who have dealt with them 
will say that treatment within any ordinary institutions is quite as 
unsuccessful. Mental instabiUty is more prominent than mental 
defect in practically all of these cases, — ^they are not merely un- 
trained feeble-minded. The mental defect, however, is there, and 
the community should treat them not as delinquents but as the 
doubly defective individuals that they are. 

Work to make the defective safe for the community should go 
side by side with effort to make the community safe for the defect- 
ive. This to be effectual must cover a wide range, from education 
of the community on the significance of feeble-mindedness and the 
necessity of special provision, to the enforcement of all laws for the 
protection of children and the security of public morals. 



'70 The Annals of the American Academy 

Just as the methods found specially adapted to the teaching of 
the feeble-minded have contributed much to the educational 
niethods applied to the normal child, so the social treatment of the 
defective on the individualistic basis is bound to point the way for 
better methods of dealing with social problems among the normal. 
So-called individual work with the normal group is much more fre- 
quently personal than individual, and failure in the social handling 
of the normal individual is undoubtedly often due to this fact. The 
obvious defects in the feeble-minded make it necessary to search out 
and determine the value of any positive quahties that he may possess 
and weigh them against the defects. The psychologist or psychia- 
trist in interpreting the individual furnishes a basis upon which 
truly constructive work may be done, when the social worker knows 
the best and can foster it and knows the worst and can fight it. 



CASE WORK IN THE FIELD OF MENTAL HYGIENE 
By Elnoea E. Thomson, 

Executive Secretary, Illinois Society for Mental Hygiene. 

The attitude of mind of the social worker — perhaps especially 
in the field of mental hygiene — cannot be better stated than in the 
words of Dr. Meyer quoted by Miss Richmond: "A wilHngness to 
accept human nature and human doings as they are before rushing 
in with the superior knowledge of how they ought to be. The first 
need is to know what they are." The motto of every social worker 
and investigator should be that of Terence's Heauton Timoru- 
menos: ". . . . One who investigates must be ... . 
ready to accept .... anything human beings think, feel or 
do as not altogether strange to human nature : ' I am but human and 
I do not consider anything foreign to me'; it is at least worthy of 
human consideration." 

This implies forbearance with the patient, the relatives, espe- 
cially those by marriage, other agencies, — -already wearied with 
much effort in the patient's behaK — the courts and the state offi- 
cials. It imphes also an ability to reflect the patient's point of view 
and not one's own, to report symptoms and to know facts. Above 
all it implies honesty and straightforwardness in deaUng with all 
concerned. 

Patients are referred to the mental hygiene social worker in 
many different ways: in person, through other agencies, through rel- 
atives, physicians, institutions, neighbors, courts, schools, etc. and al- 
ways because of some form of unusual behavior which may manifest 
itself in an inability to adjust to surroundings, or to acquire knowl- 
edge, deep melancholy, addiction to drugs or to alcohol, unreUable 
or irrelevant statements, ideas of persecution, unusual demands, 
threats against individuals or groups, etc. It necessarily follows 
that any plan for investigation must be elastic to meet the deniands 
of the individual case. 

The first contact with the patient is often extremely difficult 
and the successful worker in this field must be resourceful and a 
responsive listener. Miss Richmond writes : 

71 



72 The Annals of the American Academy 

The important things in initial interview are privacy, absence of hurry, 
frequent change of topic with some deliberate padding to ease the strain, particu- 
larly "when irritation begins to adulterate the account," and yet through all a 
clear conception on the part of the interviewer that a certain goal must, if possible, 
be reached, and a slow, steady, gentle pressure toward that goal — this, in brief 
is our program. Giving the patient all the time he wants often leads to that fuller 
self-revelation which saves our time und his in the long run. Pressure of work! 
Lack of time I How many failures in treatment are excused by these two phrases! 
But wherever else the plea of lack of time may be valid, it is pecuharly inappro- 
priate at this first stage, for no worker ever has leisure enough in which to retrieve 
the blunders that result inevitably from a bad beginning. 

If the first interview is successful a friendly relation with the 
patient will have been estabUshed and can be maintained during 
the period necessary for further study before making a plan for 
examination and treatment for, unless this interview or the history 
obtained from other agencies has brought out symptoms which 
indicate that the patient is a definite menace to himself or the com- 
munity, it is usually wise to delay a cUnical examination until the 
social history is complete, for the recommendation of the specialist 
as to treatment whether institutional or otherwise is often dependent 
on the social history. In other words, a chronic mental case in 
which treatment is unlikely to be of benefit and only custodial care 
is required, is institutional or not according to the reaction to the 
hallucinations or delusions as shown by the social history. The 
modern clinician with his well developed social attitude is unwilling 
to make a recommendation without such history. 

Thus the. social service worker in the mental hygiene field must 
know the value of evidence. All the primary work must be for the 
purpose of the mental examination and must be truthful and exact. 
Curious experiences are often founded upon fact and must not be 
termed delusional until their unreasonableness is clearly established. 
Symptoms of physical disease must be noted and if indicated a 
thorough physical examination secured and the findings submitted 
with the social history at the time of the mental examination. 

In the gathering of this history which must take into account 
both heredity and environment, the well trained worker knows the 
evils arising from too much questioning of the patient and avoids 
anything which simulates a mental examination. An indiscretion 
here may make more diflBcult the later examination and the treat- 
ment which is to follow, for an examination that does not lead to a 



Case Work in Mental Hygiene 73 

plan for treatment is of little value. A word here should be added 
against the very common practice of taking a patient from clinic to 
clinic. This is not only unprofessional on the part of the worker 
but often results disastrously for the patient, who soon loses confi- 
dence in both social workers and physicians and becomes an even 
more puzzling social problem. 

Numerous difficulties, however, are likely to be encountered in 
efforts to work out plans for treatment. Frequent statements like 
the following will be given the worker: "This patient is not in need 
of institutional care but needs congenial work in a good environ- 
ment with understanding direction." Practically the only way to 
meet the need of such patients is to establish, in connection with 
the field work, an occupational department where training and 
employment under skilled supervision can be provided. In estab- 
lishing such a department the prime necessity is, of course, the 
director, who must be a well trained teacher who understands 
abnormal individuals and not only knows various handicrafts but 
can also teach her pupils to produce articles which have a sale 
value; for such a.department will not be a success unless the patients 
have the incentive of economic return for their efforts while working 
in the department. The result hoped for is such a readjustment of 
the individual as shall later make possible positions in regular 
industrial lines. This will be possible in a considerable number of 
cases, but if this cannot be accomplished at least there will be 
brought out the reasons why the patient cannot readjust and so 
make possible a working plan for continued treatment in or out of 
an institution. 

Some patients can get on very well under such continued super- 
vision as a department of occupation gives and can contribute 
largely to their own support while they would otherwise be entirely 
dependent. Another group of patients will be found, after a period 
spent in the department, to be a menace to themselves or to the 
community, and with the information gained in daily contact, 
commitment to a state hospital is made possible. Still other pa- 
tients needing hospital care, who will not at first consider it, can 
later be induced to go as voluntary patients. 

Then there is a group who are not a menace to themselves or 
the community, living in their own homes, chronic shut-ins, whose 
lives can be made much happier by occupations which can be taught 



74 The Annals of the American Academy 

them by a field teacher; the economic return may be .very little or 
nothing, but there is a distinct therapeutic effect which will at least 
make for less complicated family situations and certainly add to the 
sum total of human joy. 

The following case histories taken from our records may serve 
to illustrate. 

Prophylactic 

In the fall of 1914, a Syrian, 30 years of age, came to the United States with 
his wife and duldren. He was unable to speak the EngUsh language and such 
friends as he had were unable in tha,t time of financial depression to find any work 
for him. He had a httle money which gradually disappeared. He had been 
trained to work in metals and had brought with him to this country a little stock 
of silver jewelry, thinking by the sale of this he could increase his capital, but he 
could not sell it because he knew of no market. He became more and more de- 
pressed and finally so deeply melancholy that his wife, fearing he would take his 
own life, appealed to some Syrians whom he knew. One of these Sj-rians was a 
patient of the Mental Hygiene Society and brought this man to the office. He 
was sent to a physician for physical and mental examination and returned witfc 
a statement that his melancholy was probably due to his inability to obtain em- 
plosmient and the prescription was work. 

Work was provided for him in his own line in the occupational department. 
It was possible to find individuals interested in the silverware and some was sold ' 
almost immediately bringing in a little money; orders were secured and the man 
gradually came to look upon life from an entirely different viewpoint. During 
this time the statements made by the patient were verified and at the end of six 
weeks a position was found for him. Very shortly he was promoted and things 
have gone well with him ever since until now he is part owner of a prosperous 
grocery business in a neighboring city and is very sure that, but for the under- 
standing aid given at his time of special stress, he would have t^en his own life, 
for he was convinced that if he were out of the way his wife and-children would 
be cared for by kindly disposed individuals, but that an able bodied man should 
be self-supporting. 

Voluntary 

Patient referred by another agency in the following letter: 

We would like to refer to you the case of A. P., Ujyesis old, living at 



There is a history of insanity in the family and one of the younger 
girls is very nervous. A has lately developed a mania for cleaning every- 
thing around her. 

She had a position in an office but finally could not be persuaded to do 
anything but clean her desk, etc., and had to be dismissed. She does the same 
thing in her home and her mother feels she is getting worse. She is perfectly 
quiet so far. 

Will you kindly let us know what you can find out about her. Her 
sister G., 13 years old, is one of our patients at one of the dispensaries. 



Case Work in Mental Hygiene 75 

A call was made at the home and an interview with the mother brought out the 
following facts: 

Parents born in Germany, no relatives in America. Father, brilliant but 
very erratic, well-born but not in favor with his family. Had been addicted to 
the use of alcohol for a great many years. Four years before had deserted his 
wife and children. Mother, hard-working, plodding, of peasant parents, inter- 
ested in her children, and anxious to do all she could for them. Mother stated 
patient had been very bright in school, stood at the head of her classes but was 
always inclined to be nervous. She left school when in the seventh grade at 14 
years of age to go to work in order to help out the family income. At first she 
did piece work in a factory but it had seemed very hard for her and was given-up 
when a position in an office was found. A few months previous to our worker's 
visit, a girl in this office had suffered from some eruption on her face and body. 
Patient worried a great deal about this and began constantly cleaning her desk 
and the things about her. Finally she had to leave her work and at home was 
always shaking and cleaning her clothes. She would sit in only one chair in the 
house which she frequently washed and would not allow any one to handle any 
of her things. She realized her own nervous condition, felt that she was growing 
worse and was anxious for treatment. Appeared to be very anemic and was 
extremely emotional. 

An examination by a ne^lrologist was arranged and he suggested sanitarium 
treatment. The parish priest was interested and the patient was sent for six 
weeks to a sanitarium for special treatment. At the end of that time she returned 
greatly improved and upon advice of the neurologist was given work in our occu- 
pational department. She was still somewhat emotional but was soon interested 
in the work. It was discovered that she had considerable artistic talent. This 
was developed and through the sale of baskets which she made and children's 
toys which she painted, she was able to earn from $7.00 to $9.00 a week.- Improve- 
ment was gradual and treatment extended over a period of eight or nine monthsi 
At the end of that time, however, recovery seemed to be complete and the patient 
was able to return to her former position in an office where after two years she is 
still employed giving satisfaction and earning a good wage. In addition to this 
she is taking certain courses in an art school. 

Borderline 

Referred by Bureau of Occupations where patient had gone frequently to 
secure employment. She was a woman 50 years of age, born in the United States, 
had received high school and normal school education and had followed the 
occupation of practical nurse. She was unmarried and a Protestant. When 
interviewed she was very nervous and excitable. It was discovered that her eye- 
sight was considerably impaired but she refused to see an oculist. The landlady 
where she had lived for some time had found her very difficult and peculiar. She 
was in arrears some thirty or forty dollars for room rent but the landlady stated 
she was strictly honest and that if she secured employment would pay her debts 
but that she had been idle many months. She would not do nursing in a family 
where there was any house work and would not even take care of her own room. 



76 The Annals of the American Academy 

It was the landlady's opinion that the patient was incapable and inefl5cient. It 
was found that she was making an effort to bring suit against an emplajrment 
bureau for having referred her to a position as a domestic. Work at sealing and 
stamping envelopes was secured for her but her employers were unable to keep 
her as she was so extremely difficult. At oiu: request she was examined by a 
neurologist who stated that she had decided defects and was a social problem 
but hardly an institutional case. He advised work in our occupational depart- 
ment. As it was extermely doubtful that her earnings would support her an 
interested relief agency cooperated with us in this experiment so that the patient 
would have an adequate income during the period. In the work in this depart- 
ment it was found that not only eye-sight biit also hearing was defective and 
that she was utterly unable to adjust herself to any ordinary stiuation. She 
would make no attempt to do the work provided and was constantly complaining 
of work, teachers, other workers and food. She became very indignant when it 
was suggested that an examination of her eyes might make it possible for her to 
secure glasses which would make things easier for her. She was unwilling to take 
any type of work but that of companion to an elderly couple and unable to see 
that her special defects would make it impossible for her to get on in such a posi- 
tion. It was discovered that she was known to many physicians who all felt that 
she was not responsible, and finally she had become firmly convinced that her 
inability to get work was due to persecution. An old friend of her family was 
interviewed but stated that he was unable to do anything for h^ and could not 
put us in touch with anyone who would. He was quite sure her family history was 
negative. She had been in one of the city hospitals two years previous to this 
time as the result of an injury, had been very difficult and irritable and had been 
considered a mild mental case. Her eyes had been examined with diagnosis of 
cataract but she had indignantly left the hospital when an operation was suggested. 
Six years before she was in another hospital and in two different convalescent 
homes. In each instance she was reported erratic and difficult. 

After several months of effort to adjust her to conditions some relatives were 
found living in Chicago but she would have nothing to do with them as she con- 
sidered them her bitter enemies . Finally a position was found for her in a depart- 
ment store for the hoUday season but she remained only one day as they put her 
in the toy section and she said she knew nothing about toys. Again she made 
many complaints ^n regard to the people with whom she worked, stating that she 
was the victim of a system of persecution in which she included a physician who 
had recently befriended her and all of the agencies with which she had any deal- 
ings as well as her relatives and other individuals. The matter was again taken 
up with the old friend of her family who still felt unable to do anything. Her 
physician, after this period of intensive study, felt justified in issuing a certificate 
stating mental illness and papers were taken out for commitment to the psycho- 
pathic hospital. When this was reported to the old friend of the family he was 
inclined to be indignant as he did not feel that she was insane and thought that 
some other provision should be made. Even the liistory which had been obtained 
covering nine years of inability to adjust to any sort of living conditions was not 
convincing to him. He was told that any arrangement he might make for her 
care which included the necessary financial aid and supervision would be satis- 



Case Work in Mental Hygiene 77 

factory and arrangements could be made to have her dismissed in the care of any 
one whom he would designate. At the end of a week the patient was dismissed in 
the care of a woman who had consented to room and board her, the old friend 
agreeing to supply the funds. This is probably only a temporary arrangement, 
but the fact is estabhshed that she is physically and mentally unable to be self- 
supporting and it may be reasonably expected that no further effort will be made 
in that direction in a community having a well organized confidential exchange. 

Danger to Self or Community 

This case was referred to us by a legal society whose representative stated 
over the telephone that a patient was in their office much excited, declaring he 
could not hold a position because wherever he worked his enemies followed him 
and made his employers discharge him; that recently he had been in the Bride- 
well, having been sent there through the work of his enemies and no fault of his 
own. This patient reported at our office and proved to be an Egyptian, 30 years 
old, who had been in the United States eight years and who had for some years 
followed the occupation of ship steward or house man. He was able to make 
himself understood in many languages but unable to read or write, had never 
attended school and had no relatives in this country. He thought one sister stiU 
lived in Paris but had not heard from her for years. All of his other immediate 
relatives were dead, one brother having been killed in the Boer war. He had been 
naturalized while living in New York, had held positions in different cities of the 
United States and had apparently never stayed a great while in any one position 
but had been more than one year in Illinois. As he was out of a position and 
needed work, he was employed as janitor in our office while an investigation of 
his statements was being made. He was found to be a very good worker but in- 
clined to be sullen and easily offended. The fact was brought out that he had been 
employed in one family in Chicago for six months. Nvunerous statements which 
he made in regard to this family were found to be without foundation, and as he 
was persuaded to talk more freely of his trouble it was discovered that he felt 
this family, particularly the mistress of the household, was responsible for all of 
his difficulties, and that he had made up his mind that it would be necessary to 
take her life if he was to have any more peace of mind. 

With these facts established he was examined by a specialist who issued a 
certificate for his commitment to the psychopathic hospital where he was per- 
suaded to go by one of our field workers. Later he was committed to a state 
hospital for the insane, where he is now under care and treatment. 

After Cake 

This was a young woman, 37 years of age, born in the United States, who had a 
high school education. Her history was one of considerable instabihty during her 
childhood and early womanhood and she was committed to the state hospital in 
maniac state. Paroled during the first year of hospital residence, she was retmmed 
within a few weeks in a highly excited condition and had been in the hospital ten 
years with no history of any mental abnormality after the first year. She was 
very agreeable, anxious to be helpful and did excellent needle work. Her relatives 



78 The Annals of the American Academy 

were persuaded to give her a trial outside of the institution when given assurance 
that they could have the help of a specially trained social worker. She was 
furnished employment in needle work and later was given training in certain 
special classes in work for which she seemed to have a liking. At first frequent 
visits were made to both relatives and patient in order to reassure them. The 
patient has had no recurrence of her mental difficulty and has been self-supporting 
for the past six years except during two very severe physical illnesses during which 
time she was cared for in a general hospital. Both relatives and patient have 
relied for advice upon the social service worker. 

Case work in mental hygiene, then, is of benefit to the individual 
and, in cooperation with other agencies, to the family and to the 
community. But it has another and even more far-reaching func- 
tion — for the records honestly made with proper regard for "the 
value of evidence" are an important contribution to the research 
worker in the mental field where so much still remains to be Ascer- 
tained as to the causes of certain forms of mental disease and 
methods for prevention. 



THE FATHERLESS FAMILY 

By Helen Glenn Tyson, 
State Supervisor, Mother's Assistance Fund of Pennsylvania. 

Before the movement for mothers' pension legislation spread 
over the United States after 1911, there were two general forms of 
administering relief to fatherless families. The first was through 
private agencies, many of which have for more than a decade 
realized that the only constructive solution of the poverty problem 
presented by the fatherless family is a regular allowance on which the 
widow can depend to free her from worry and overwork and enable 
her to give her children real home care. The other form of admin- 
istering aid was through the public agency for outdoor relief. Under 
the old Poor Laws, meager allowances had always been granted to 
widows, but never on any adequate basis; nor had the public offi- 
cials administering this relief formulated any pohcies as to standards 
of family life to be required in the families aided, nor defined the 
quality of service to the children that could reasonably be demanded 
from the mother. 

While a few states have developed their mothers' pensions 
system simply through an extension and re-interpretation of the 
old outdoor relief laws, the general form of the new public adminis- 
tration of relief has been through the courts. This seemingly 
chance development was probably due to the fact that in a number 
of states the courts still have jurisdiction over dependent children 
and that one of the best-known Juvenile Court judges in the coun- 
try was the first to make an effort to have the jurisdiction of this 
court extended over such dependent families. Then, too, there was 
the greatest distrust and dissatisfaction with the old outdoor relief 
agencies among those interested in public welfare, and it seemed to be 
the easiest solution to divorce them entirely from the new adminis- 
tration of this form of aid. The states that have recently passed 
mothers' pension legislation, however, have realized how unsatis- 
factory administration of relief through the court is apt to be, 
a,nd recent mothers' pension laws — notably those of New York, 
Pennsylvania, Delaware, and New Jersey — have created an en- 

79 



80 The Annals of the American Academy 

tirely new piece of administrative machinery based on the plan of 
county organization, but with state supervision or control. These 
efforts to separate this group of dependent families for special treat- 
ment reveal a new reahzation that the community as a whole is 
largely to blame for the ills-that afflict individuals, and a growing 
conviction that from the point of view of self-interest alone, the 
state must assume greater responsibility for the welfare of its 
children. In 1909 the Royal Commission on the Poor Laws of 
England recommended unanimously that the old poor law machin- 
ery be abandoned and a new public assistance authority be created. 
This year, 1918, in the midst of England's most costly war, this 
plan has been actually carried out and the new plan comprehends 
all forms of relief and special provision for dependents and de- 
fectives.^ 

Our new Mothers' Assistance legislation, haphazard and un- 
standardized though these efforts to meet the needs of fatherless 
famihes through public action have seemed, has nevertheless these 
significant effects: definite opportunity is offered to the state to 
discover the causes of the untimely deaths of the fathers, at the very 
time of their greatest usefulness to society, industry and the fam- 
ily; also, the chance is given to estimate the cost to the state of 
preventable deaths of the breadwinner and the loss entailed by the 
subsequent dependency of the helpless family.^ With these facts 
as a basis for further action mothers' pension legislation should soon 
be taken over as an integral part of the larger and more construstive 
plan for social insurance.' Yet even under such a system of state 
organization a certain number of young fathers will continue to die 
untimely deaths, leaving their families unprotected by any form of 
insurance and in need of organized assistance. 

When the average individual hears the term "widow" if he does 
not think of the fictitious person named to obstruct any economic 
reform, there instantly flashes into his mind a type picture of the 
"poor widow" of sentimentalism : a frail, hard-working devoted 

'Bruno Lasker, "The Dcatli Blow to England's Poor Law," The Sim-cy, 
Feb. 23, 1918, pp. 563-564. 

2 Report of Special Inquiry Relative to Dependent Families in Massachu- 
setts Receiving Mothers' Aid, 1913-17, Senate No. 244, pp. 77-141. 

' Final section of report on work of Mother's Assistance Fund in Pennsyl- 
vania, pamphlet of State Board of Education, in press. See also, Commons, 
J. R., and Andrews, J. B., "Principles of Labor Legislation," pp. 406-409. 



The Fatherless Family 81 

mother, bending over a wash-tub and surrounded by a large group 
of hungry children. While there are no more innocent and pitiful 
sufferers from our unorganized social system than the widow and 
orphan, social workers know that there are as many kinds of widows 
as there are kinds of women. At one end of the line is the capable 
mother who will make any sacrifice to keep her children with her and 
rear them in decency and comfort ; at the other, the weak or vicious 
woman who will exploit, neglect or abandon her children on the 
slightest pretext. 

For the purposes of this paper the family with adequate finan- 
cial resources is not considered; nor is the one where deterioration 
in the values of family life (whether due to environmental causes or 
individual defect) has compelled the breaking up of the family to 
save the individuals that compose it. The following discussion is 
limited to those fatherless families, where, with adequate income, the 
children bid fair to become normal useful citizens under their 
mother's care. 

Whether relief to a fatherless family is administered through a 
public or a private medium, there are certain prerequisites of as- 
sistance which all agencies endeavoring to follow modern methods 
of social service have established. Investigation should not stop — 
as all too frequently in the past,^ — with the proof of the fact and 
degree of need of the family. A full consideration of the financial 
resources available in the way of help from relatives, property or 
money owned by the widow, her own or her children's abihty to 
contribute without harm to the support of the family is of course 
essential. But the value of the family life measured through a con- 
sideration of the mother's mental, moral, and physical fitness to 
bring up her children must also be determined by investigation. 
Assistance should not be given in famiUes where the mother is 
mentally unsound or defective, morally weak, or physically unable 
to give the children decent home care. Finally, investigation 
should show the basis of a plan for the future welfare of the family. 
After the decision to grant assistance is made, the social case treat- 
ment of the family should be organized about this plan. 

In any family the elements of normal life are disrupted by the 
death of the breadwinner. His loss is more than the loss of a pay 
envelope. At this stage of the social and economic development 
of woman the removal of the father of the family is apt to have a 



82 The Annals of the American Academy 

very serious effect upon the family's solidarity. His loss is felt in 
the making of plans for the spending of the income effectively as 
well as in the loss of the income itself. There is great need of his 
discipline and advice in the training of the children, especially in the 
case of growing boys. In certain foreign groups particularly, where 
the status of woman is regarded as so much lower than that of 
man, it seems almost impossible for a mother no matter how de- 
voted and earnest, to control and guide her restless, adolescent son. 
Often, too, the father has been the one to attend to such business 
details as the payment of rent and insurance dues, the one to ar- 
range for necessary medical care for the children. The father also 
gives the family a certain social and economic status in the com- 
munity through his relation to labor organizations, employers, and 
pohticians. His advice at the time the children begin to enter in- 
dustry and to choose occupations for themselves is usually sorely 
needed. To supply all these weaknesses in the family life is the 
task of the social worker who administers relief to the family and 
supervises their welfare. 

In many ways the fatherless family offers the ideal group for a 
demonstration of the value of social case treatment provided that 
the assistance given is adequately and wisely planned. The Home 
Service of the Red Cross baises its strong claim to serve the families 
of soldiers and sailors on similar grounds.'' A growing family of 
normal children offers every opportunity for constructive study and 
guidance. The mother is free from the strain of child bearing and as 
the children grow older can give more attention to the development 
of family life. The fact that the income is adequate and steady and 
not open to fluctuations due to unemplojaiient, illness of the bread- 
winner, or personal weaknesses on his part such as drunkenness and 
brutality, enables the mother to gain habits of foresight and thrift 
that she has perhaps never been able to develop before. A study of 
the social records of families adequately assisted and well super- 
vised shows that in many cases a rise in the sta^idard of living of the 
family has actually been achieved. Certainly there can be no more 
satisfying result in social case treatment than the "graduation" of a 
widow's family into complete independence, ^^■ith fuller social con- 
tacts, good educational grounding, and a well-rounded family life. 

After investigation has established the fact and degree of need 
• A. II. C. 201 "Manual of Home Sorvicc." Seoond edition, pp. 31-46. 



The Fatherless Family 83 

of the family, discovered all available and legitimate resources to 
meet that need, and found that the mother is mentally, morally, 
and physically fit to perform her normal duties to her children, the 
first step in the plan for future supervision is the consideration of a 
sound financial basis on which the family should be maintained. 
Unfortunately it is still true that most fatherless families do not 
come to the attention of any social agencies, public or private, until 
some time after the death of the man. This period is almost sure 
to be one of family deterioration. The strain of the father's illness 
and death, the pressing need of the necessities of life, the demands 
on the mother's time and strength from her effort to support the 
family and maintain the home all tend to involve her in difficulties 
that she could not surmount alone. Through the widow's short 
sightedness or total ignorance of the world of business, the insurance 
money sUps in a few weeks through her fingers. Dozens of instances 
can be described by social workers where a designing "friend" of 
the husband has taken advantage of the widow's ignorance to ap- 
propriate the larger part of the small lump of insurance, or where 
well-meaning -neighbors or friends have given her just the kind of 
advice most certain to deplete her httle fund. The usual bad in- 
vestment of this sort is either the buying of a home under a heavy 
mortgage in a congested or neglected neighborhood, chosen with no 
consideration of sanitation, neighborhood conditions, or nearness 
to work and school; or the expenditure of the few hundred dollars 
for stock for a Uttle store. In hundreds of such instances the stock 
has soon been sold; there is of course no capital to replenish it; 
and finally the Uttle store closes and the family's small reserve fund 
vanishes with it. 

It is surprising to social workers to find how frequently women 
have not been allowed by their husbands to handle money even for 
the household needs. Obviously it takes a certain amourit of fore- 
sight to save ahead for the rent and insurance and even more to 
realize that furniturfe or other household necessities bought on the 
installment plan are not a good investment. Before working out a 
budget of living expenses for the family, the case worker usually 
must spend some days in discovering what the family's habilities 
are, and in straightening out a tangle of unpaid bills, lapsed in- 
surance poUcies, and installment charges. 

After the existing economic resources of the family are dis- 



84 The Annals of the American Academy 

covered, the next consideration involves deciding which of these are 
legitimate assets that can be counted on for the future, and which 
part of the income should be cut off or decreased for the well- 
being of the family. In many states the law determines the max- 
imum amount of property and money a widow may have and still 
be eligible for assistance. There is some difference of opinion and 
legal provision on this question, varying, for example, from the 
law in Illinois where a mother is disqualified for assistance if she 
possesses any property and money, to California, where a maximum 
of five hundred dollars in cash and a thousand dollars in property 
is allowed. The consensus of opinion seems to be that some equity 
in property, provided it is the widow's own home, tends to add to the 
self-respect and thrift of the family and to keep them in the neigh- 
borhood and town where they have become established and where 
all their natural social contacts have been made. The sacrifice of 
a home to most people brings great discouragement and the feeling 
of loss of social standing. Then too, many instances prove that it 
would have been actually cheaper to assist a mother who owns her 
home, provided the home was suitable to the family's' needs and not 
deteriorating in value, than to insist that she sacrifice it at a forced 
sale only to become a heavier charge on the community later. 

In the matter of money in the bank, since for the sake of econ- 
omy in the distribution of available funds the amount of the monthly 
grant must be based on a necessity standard of living, a little surplus 
is invaluable for meeting emergencies of sickness and accident that 
constantly arise in a family of young children. This small reserve 
sum, however, should never be regarded as a source of income to be 
drained gradually through an inadequate grant; and the undei^ 
standing with the mother should be that it is only for emergency 
needs. Yet there is no doubt that its possession adds to her feeling 
of independence and security from want. 

In considering the question of relatives as a source of income the 
tendency seems to be for public agencies to take a different attitude 
from that held by private societies. If rehef is given by a public 
agency the attitude of the community usually is that a widow's rela- 
tives like other citizens of the state are contributing to her need 
through taxes and, except where the law holds them legally respon- 
sible for her support, that they have a right to claim exemption from 
that responsibility. There are of course many cases in which rela- 



The Fatherless Family 85 

tives, not responsible under the law, have willingly shared with a 
public agency a part of the economic burden of the family. The 
insistence of private agencies on the fullest possible aid from rela- 
tives is founded on the belief that only through the enforced sense 
of mutual responsibility can family solidarity be maintained, and 
that loyalty to one's own kin is a human value which must not 
beallowed to go to waste. Whether such human values are actu- 
ally enhanced by insistence on financial help from relatives already 
struggling to make ends meet is open to question." There is no 
question, however, that the financial and social status of the rela- 
tives should be determined and their help, particularly in other 
than financial ways, enlisted for the family. 

One of the first methods of increasing income to which the needy 
widow turns is the keeping of men lodgers. Through bitter experi- 
ence over many years and with a large number of famiUes, social 
workers are unqualified in their disapproval of this method of adding 
to the iocome. Aside from the fact that the presence of any stranger 
has a disrupting effect upon Ae family life there are many general 
considerations that render the policy a bad one. The effect of the 
men's influence on the growing boys is often bad, the difficulty of 
making decent sleeping arrangements in a small house, and the ac- 
tual danger of physical violence to the woman or the Uttle girls in the 
family must be considered. Quite often gpmpanionship and pro- 
pinquity lead to intimacy; and illegitimate children make the fam- 
ily problems more difficult. Even close supervision cannot ward 
off these dangers. In the case record of a family which has been 
under the supervision of one of the best private agencies in the 
country since 1911 we find the following significant entries: 

10/2/11, Widow a particularly sweet, appealing person. Children clever 
and most attractive. On account of high type of woman it seemed safe to allow 
her to keep her three boarders. They are a good class of men, interested in the 
children and helpful with them. When the children need treatment, Nick, one of 
the boarders, takes them to the hospital. 

10/20/13, State Dispensary reports that they suspect pregnancy. This was 
confirmed later by a private physician. 

2/17/14, Henry, 12, removed by Juvenile Court. 

5/2/14, Toney, 10, removed by Juvenile Court. 

7/7/16, Polney, 10, removed by Juvenile Court. 

6 See discussion "A Misplaced Burden," Charities and the Commons, Oct. 13, 
1906, p. 118. See also I. Rubinow, "Social Insurance," pp. 313-315. 



86 The Annals of the American Academy 

According to the other entries in the record this family shows a 
slow but steady deterioration. If a firm stand on the lodger ques- 
tion had been taken in the beginning, immediately after the hus- 
band's death, it is possible that the breakdown might not have 
occurred. 

Another usual source of income for the family and one to be 
considered most carefully is the mother's own earnings. In judg- 
ing whether or not a mother receiving assistance should contribute 
to the family's support, exactly the same considerations,should hold 
that govern any mother's decision about work outside the home. 
That is, the question of whether she should add at all to the family 
income and to what extent, should be decided by a study of the age 
and number of the children, the condition of the mother's health, 
the provision of care for the children during her absence, and also 
her own inclination, capacity and past habits. No intelligent plan 
about the mother's work can be made unless the amount which she 
adds to the family budget be regarded as of secondary importance to 
these other determining questions. 

Study of the industrial conditions of working mothers has 
shown that the large majority are employed in unskilled, un- 
standardized work at the lowest wages and for the- longest hours.* 
OfRce cleaning seems to be the work usually condemned by social 
workers for the mothei^of young children on the ground that it is 
extremely fatiguing and comes at just the time of day, morning and 
evening, when she is most needed by the children. Of course, a 
busy mother, who works at night, finds it very difiicult to get the 
proper amount of sleep during the day and at the same time perform 
her household duties and give her children the proper care. There 
is also a frequent temptation to the fatigued mother in going through 
the streets in the cold and dark to take a stimulant or make un- 
desirable acquaintances. The fact that even trained social work- 
ers are sometimes strangely blind to the dangers involved in per- 
mitting the mother to do this kind of work is shown in the following 
extracts from the case record of an assisted family : 

Mother with 6 children, ranging from 15 months to !)J years. 
6/5/15 M. working at K. & B. Dept. store 4 hours every evening. Receives 
SI a day. 

"Katherine Anthony, "West Side Studies: Mothers Who Must Earn." 
R. S. F. Survey Asxociales, June, 1914, p. 153. 



The Fatherless Family 87 

1/18/16, Visitor found a man sitting at the kitchen table in the evening. 
Said he lodged in the same house and watched the children evenings while the 
mother worked. 

3/29/16, Petition filed in Juvenile Court. Children neglected. Mother 
illegitimately pregnant. 

While other factors than the mother's night work probably con- 
tributed to the deterioration of this family it is clear from the entries 
in the record that it was the chief cause. If it is necessary and de- 
sirable that the mother supplement the income, the consensus of 
opinion seems to be that sewing, fine laundry, or the care of other 
dependent children are more desirable than the usual forms of work 
because these occupations do not demand fixed hours of labor, and 
can be carried on at home while she is attending to her family's 
needs. 

The question of the contribution of working children to the 
family income is one that can be summarized briefly. In order to 
increase the family income, no child should be forced into work pre- 
maturely, or under conditions that jeopardize its health or future 
development. It is equally true that a child should not be permit- 
ted to contribute more than a reasonable amount of its wages to the 
support of the family and should not be made to feel that the family 
is dependent on its earnings to an undue degree. 

After the family resources in property and money, financial 
help from relatives, and ways in which the mother and children may 
safely add to the family income are considered, the question of the 
budget on which the family may be expected to maintain a good 
family standard must be decided. There is no doubt that contin- 
uous and adequate relief can be used as a lever to lift family stand- 
ards of living, and that it is not money aid in itself but the method 
of administering it that may do harm . One of the arguments against 
public assistance is that it lacks the elasticity of private relief and 
cannot easily be adapted to the changing needs of the family. But 
this is equally true of the weekly wage of the father, and the average 
family must plan on a fixed sum. The feeling of security which a 
fixed monthly or weekly allowance gives to a widow enables her to 
develop those qualities of foresight and thrift by which she may plan 
ahead for the winter's coal or the next month's rent. 

So much scientific and detailed work has been done on budget 
planning for assisted families that it is unnecessary to describe it here 



88 The Annals of the American Academy 

The one basic principle, however, is that the amount granted, if ex- 
pended with reasonable care, must be adequate to ensure mainte- 
nance of health, working efficiency, and a good standard of family- 
life. 

It is no exaggeration to say that there is hardly a family apply- 
ing for assistance in which at least one member does not show signs 
of malnutrition or disease. In the mothers the strain of child 
bearing, overwork, worry and enforced neglect of the simplest 
rules of hygiene have often resulted in chronic functional disorders 
or in conditions requiring surgical care; varicose veins, gynaecolog- 
ical and digestive disorders, flat feet and cardiac trouble are ailments 
common to these mothers. Among the children, disorders due to 
neglect and under-nourishment are prevalent and there is great 
need for the medical treatment of skin diseases, throat conditions, 
anemia, eye strain, and other disorders that may result in serious 
retardation in school and later in industrial efficiency. To meet 
these health needs the aid of private physicians, hospitals, conva- 
lescent homes and sanatoriums must be enhsted. 

In outlining a plan for supervision for a fatherless family it is 
well to decide what changes in the family life should be made at 
once. Even if emergency aid only is given for a few days, it is 
often wise to withhold regular assistance until a child who has been 
illegally employed is back in school, the man lodger eliminated, and 
in some cases until a member of the family in urgent need of medical 
care is actually under treatment. When regular assistance begins, 
the mother's hours of work should be changed at once to meet the 
plan for proper home care of the children. Other changes, such as 
the improvement in the school records of the children, training the 
mother in budget keeping, and securing dental care for the family, 
may require months of regular visiting and patient effort. 

In this attempt to ensure the progress and welfare of the fam- 
ily it is perhaps unnecessary to say that the advice and help of 
clergymen, school teachers, former employers and relatives are 
needed. Other social agencies can often render the special kind of 
service that is required to fit some particular need. A housing as- 
sociation may be consulted about a sanitary home in a good neigh- 
borhood; a visiting nurse called in if there is sickness in the family; 
a vocational guidance bureau requested to advise the children as 
they approach working age; the interest of a settlement or commun- 



The Fatherless Family 89 

ity center enlisted to secure recreation and wider social contacts for 
the family. 

The reading of a considerable number of records of assisted 
f a,milies in several cities that had been under the care of either a pub- 
lic or private agency showed that there are still valuable opportuni- 
ties in supervision that have hardly been touched. In many cases 
the influence of the personality and ideals of the dead father is a vital 
"factor in the family life, yet only in isolated instances was there any 
reference to his plans and ambitions for his children. While many 
records show an attempt to regulate the hours and working conditions 
of the mother, there were practically no instances where she was 
offered the opportunity of training for more highly skilled and better 
paid work. In view of the fact that she is usuallly quite young and 
will often be obliged to contribute to her children's support for many 
years to come, it would seem a wise economy to consider this pos- 
sibility of increasing her earning power. While the children are 
often put in the way of obtaining healthful pleasures and forming 
helpful friendships, the same need in the life of the mother is not 
considered. In one agency a special effort was made to encourage 
the mothers of assisted families to join mothers' clubs, attend night 
school, and seek some social connection outside the home. A study 
~ of one hundred records of this agency showed that at the time the 
grant was made eighty-five of the one hundred mothers were highly 
nervous and depressed.^ After the families had been supervised 
and aided for a year only fifteen of the eighty-five had failed to be- 
come cheerful and self -controlled. Certainly this remarkable 
change must have been due to some extent to the social contacts 
the mothers had made. i 

Assistance and supervision of fatherless families under existing 
community organization can only be rendered successfully by trained 
social workers; but in most communities there is not only no devel- 
oped social consciousugss, but no one who knows the technique of 
social service. It is clear that a full measure of state supervision 
and state aid is badly needed in all such communities: A social 
reform measure, introducing an intricate new mechanism, but left 
to the isolated local community to administer, is doomed to in- 
efficiency. Payment for adequate investigation and supervision in 
most communities must be made out of state funds, and be under 
state control if the work is to be successful. ' 



90 The Annals of the American Academy 

It has been repeatedly pointed out that the only just way to 
solve the problem of the widow and orphan is to reduce their number 
by seeking to keep the wage-earner alive. The really preventive 
remedy here is social insurance. The insurance principle makes 
premature deaths expensive and so tends to reduce their number. 
The insurance method is also effective in making it possible for 
the wage-earner to provide for his own wife and children in case of 
his death, without leaving them to be cared for by any relief agency, 
private or public. 

The theory and even the practice of the mothers' pension work 
are more closely identified with public relief than with the preven- 
tive measure of insurance. It provides state grants for dependent 
families, on proof of destitution, for the purpose of enforcing a 
measure of state guardianship over the health and education of its 
wards. As has been shown, emphasis is placed on moral considera- 
tions as well as financial need. Where it has been successfully ad- 
ministered it represents a new and fine piece of pubUc machinery, 
made effective by its use of the approved methods of private 
agencies. With the thorough-going social reform that is likely to 
follow the war, and which is in fact already under way in England, 
our antiquated poor laws will be done away with. The unemployed, 
the old, the sick, the invalid, and the widow and orphan as well, may 
soon be cared for democratically by social, or contributory, insur- 
ance. Yet even under such as advanced social organization there 
will still be a residuum of individuals and families requiring social 
case treatment. It is to be hoped that out of America's significant 
new experiment in public charity^ — the mother's assistance work — 
may ultimately come a superior piece of pubhc relief machinery re- 
placing the old and discarded outdoor relief, and embodying all the 
principles of case diagnosis and treatment that have been worked 
out so carefully by the private agencies in the past. 



DESERTION AND NON-SUPPORT IN FAMILY CASEWORK 

By Joanna C. Colcord, 
Superintendent, New York Charity Organization Society. 

Legalistic Conchptton Of Desertion 

An examination of the existing literature on family desertion 
brings to light surprisingly little regarding the problems it presents 
to the social case worker. There have been several statistical stud- 
ies of its occurrence, and innumerable discussions of its treatment 
from the legal side, but the case worker in search of technical advice 
and direction browses over a wide field with comparatively small 
result. This is probably due to the fact that the rise of the domestic 
relations courts in late years has tended to turn the thoughts of 
those interested in the problem toward the legal and judicial reme- 
dies which are being developed. It may further be due to the fact 
that workers in the field of adult probation, who constitute the 
speciaUzed group of case workers most directly interested in family 
desertion, are still breaking new ground and have not as yet been 
able to make the contribution to the literature of the case work 
movement that we may confidently expect to have from them in 
the course of the next few years. 

Whatever the cause or causes, it seems true that desertion is 
generally written about as a breach of the law, to be dealt with 
through the correctional agencies of the community. This is not 
so much an erroneous as a distorted view of the problem. It fails 
to take into account the loss and wastage in human life, and em- 
phasizes rather the financial burden of dependency which is laid 
upon society. Both elements of course exist, and must be recog- 
nized no less by lawyers and judges than by social workers in any 
effective program for the treatment and prevention of desertion. 

It may as well be admitted that the hopes which social workers 
entertained at the beginning of the domestic relations courts move- 
ment have not been in all respects realized. What the social 
worker hoped for was an institution which would administer justice 
based upon the principle,s of social case work; but while much has 
been gained, we still fall far short of this. The law still insists upon 

91 



92 The Annals of the American Academy 

regarding the important element in family desertion to be the 
deserter's evasion of his financial responsibility and the rendering 
of his family a public charge. That there can be degrees of culpa- 
bility in the deserter, aside from the financial question, is not 
always apparent to the legal mind. The chairman of a case com- 
mittee, a lawyer, and one of the most large-hearted and compassion- 
ate of men, maintained that the graver fault of a young deserter who 
had left his mfe and two infants penniless in a strange city, while 
he went on a three-weeks pleasure trip, lay in the fact that he had 
embezzled fifty dollars from his employer to finance the excursion! 

There is still much confusion as to the location and extradition 
of deserters, and in most cities the burden of finding the missing 
husband and serving the summons upon him is still unrelentingly 
placed upon the shoulders of the wife. Extradition from without 
the state is made difficult by lack of appropriations, and by the 
indifference of district attorneys who feel that no good end is served 
by bringing a man back on a felony charge to serve a prison sentence, 
on the ground that "he will be of no more use to his family here than 
there. " A study made by Mr. William H. Baldwin of prison terms 
served by returned deserters indicates that these are not usually long 
enough to act as a real deterrent. Indeed, so involved is the ques- 
tion of extradition, that one sympathizes with the bewilderment of 
the social worker in New York, who said: "As far as I can see, if a 
man deserts and goes across the ferry to Jersey City he is guilty of a 
felony, but if he gets as far as Buffalo he is only a disorderly person! " 
Another anomaly is that contained in the proposition that the wife 
can claim abandonment only on behalf of her children. A man 
living with his wife and five-year-old boy in an eastern city, eloped 
with another woman to a city in the middle west. The couple kid- 
napped the boy and took him with them, and the distracted mother, 
bereft of both husband and child, had no recourse in any court, 
since the father was continuing to provide for his son. 

These are instances, however, of shortcomings in the law rather 
than in the technique of dea,ling with desertion by correctional 
means. Under the latter heading, unsatisfactory results are most 
often to be ascribed to the reliance which some of the courts stUl 
place upon the contrasted statements of the husband and wife, sup- 
ported it may be by the testimony of their respective friends. To 
the legal mind it may seem an heretical statement, but the social 



Desertion and Non-Support 93 

worker is convinced that testimony concerning family desertion 
which is drawn out in court, and unsupported by any careful social 
investigation by a trained worker, is often worse than useless. The 
causes of this particular form of family breakdown are often too 
obscure to be apparent to the persons immediately concerned, even 
if both are honestly trying to give a straight account, and if one or 
both are not making such effort, the advantage goes to the side that 
can put up the better story. When a sufficient number of well- 
trained probation officers are attached to the court to make the neces- 
sary preliminary investigations, this danger does not exist; otherwise 
it is always present. There is something about the factors involved 
in desertion cases, that seems naturally to arouse the prejudices of 
the individual who deals with them. Women social workers are 
notoriously prone to take the part of the woman without giving the 
man a hearing in cases of marital difficulty; employers are equally 
likely to feel that there is much to be said on the man's side, espe- 
cially if they have never seen the wife. The only way in which this 
perfectly human tendency can be corrected is either to make or 
have made for one a careful, skilful and painstaking inquiry into the 
real facts of the case, obtained from as many well-informed and dis- 
interested sources as possible. In other words, until the courts 
which deal with social problems like desertion and non-support will 
consent to abandon their traditional dislike for "hearsay evidence" 
presented and gathered by social workers, they will fall short of 
administering the highest quality of social justice. 

Social Conception of Desertion 

The effect of centering the treatment of deserters and their 
families in the courts has brought about, even in the mind of the 
social worker, the feeling that they constitute a class by themselves, 
presenting problems different from those of other famihes, and call- 
ing for an entirely different technique in their handling. Dr. E. W. 
Eubank, who has recently made a careful survey of the problem in 
Chicago and other cities of the United States, makes as one of his 
leading recommendations the suggestion that social agencies dealing 
with families, attempt, so far as possible, to center the handhng of 
desertion cases in one person or department. There is room for a 
good deal of difference of opinion on this point, and its advisability 
may well be questioned for more than one reason. While a certain 



94 The Annals of the American Academy 

facility is gained through having the dealings with the courts, dis- 
trict attorneys, etc., in the hands of one or a few people, the plan 
necessarily prevents other members of the staff engaged in general 
case work from the opportunity of handling the whole problem in 
desertion cases. Furthermore, it only confirms and extends the 
tendency to regard deserters and their families as a class apart. 
The experienced case worker knows that desertion is in itself only a 
symptom of some more deeply seated trouble in the family structure. 
It constitutes a "presenting symptom" which does, indeed, indicate 
some one of a few specified forms of treatment at the outset, but 
which also involves all of the foresight, patience and skill which the ' 
social case worker knows how to apply, if any sort of permanent 
reconstruction is to be accomphshed. Behind a man's abandon- 
inent of his home and family there is sure to be a wide variety of 
causes, some external and easily to be recognized; others rooted 
deeply in the subconscious instincts and aversions of the people 
concerned. What these individuals are able to tell is often strangely 
petty and inadequate without the interpretation which applied 
psychology is able to give. One man stated that what gave him the 
final impulse to leave home was his wife's filling his bed with ashes. 
As legal evidence, this would seem ridiculous; to the social worker 
who had studied the two temperaments closely, it was an interesting 
and significant detail. 

In this way a great number of widely different family problems 
seems to be superficially ahke only because the breakdown has be- 
come so acute that the actual physical disruption in family life has 
begun. The case worker recognizes that while the absence of the 
man involves certain difficulties in the finding of him and in the 
possibility of gtetting information from him, the case problem which 
he and his family present is not essentially different from what it 
would have been before his departure if the problem could have 
been recognized and brought to her attention earUer. She recog- 
nizes that the causes of desertion are as numerous and varied as 
the causes of poverty, if these could be ascertained, and that they 
are likely to be even more subtle and difficult of appraisement. 
Many influences from without are impinging on the home and 
the family at the present time to bring about a slackening in the 
bonds which hold it together. Considering the unrest and unnat- 
ural stresses and strains of urban life, the wonder probably is that 
desertion has not increased more rapidly than it has. 



Desertion and Non-Support- 95 

Keeping in' mind all this, the case worker sees desertion as only 
an acute form of the symptoms of weakened and crumbling family 
life. She is unwilling to accept the common theory which divides 
the treatment of desertion into two fields: one, the location, appre- 
hension and punishment of the man through the courts, and the 
other, the charitable relief of his family during the process. Instead, 
she holds that the technique of the case treatment of the deserter 
and his family is no different in essentials f roni social case treatment 
in general except perhaps in the one particular of locating the ab- 
sconder. She does not believe that reconciliatiohs can be brought 
about by short-cut methods. Most social workers have a deep- 
seated distrust, not of the principle that a function of the domestic 
relations courts is to bring about such reconciliations, but rather of 
the way in which such efforts have been made in connection with 
many of them. The wholesale attempt to patch the tattered fabric 
of family life in a series of hurried interviews held in the court room, 
and without any information about the problem except what can 
be gained from the two people concerned, can hardly be of perma- 
nent value in most cases. It is natural that case workers, keenly 
aware as they are of the long, slow, and difficult process involved 
in character-rebuilding, look askance at court-made reconcili- 
ations. With the best will in the world the people who attempt 
this delicate service very often have neither the time nor the 
facts about the particular case in question to give the skilful 
personal service necessary to reconstruction. As a result many 
weak-willed wrong-doers are encouraged to take a pledge of good 
conduct which they will riot, or cannot, keep; and other individuals 
who feel themselves deeply wronged go away with an additional 
sense of those wrongs having been underestimated and of having 
received no redress. The results are written in discouragement and 
in repeated failures to live in harmony, each of which makes a 
permanent solution more and more difficult. The case worker to 
whom the results of the externally imposed reconciliation come 
back again and again has reason to be confirmed in her distrust of 
short-cut methods. In order to demonstrate which contention is 
right there is great need for a careful study, made one or two years 
after the reconciliation has taken place, of a large group of couples, 
the solution of whose troubles has been attempted in this way. 
Unless there should be supervision for a considerable period by a 



96 The Annals of the American Academy 

skilful and resourceful probation officer all experience points to the 
conclusion that the percentage of permanent reconciliations would 
be low. 

Social Case Treatment op Desertion 

While it is true that the deserter and his family present no 
unique problem to the case worker, it is nevertheless true that cer- 
tain adaptations in case work technique are usually advisable and 
that certain points must be especially kept in mind in the course 
of the investigation.' Disparity of age, of race or nationality and of 
religion are significant factors when they are found in connection 
with this form of family -breakdown. Not less important is a con- 
ception of differences which may exist between the couples in the 
matter of education, habits, social status and moral and ethical 
concepts. A history of the background of the man and the woman 
from childhood on, keeping all these factors in mind, is essential to 
an understanding of the problem. One extremely important fact 
to have in mind, and one which should be proved or disproved 
where possible in connection with every desertion case by means of 
records of vital statistics, is whether or riot the marriage was a forced 
one. There can be little doubt from the experience of case workers 
that people who contract this type of marriage later find their way 
in large numbers to the courts of domestic relations. A piece of 
research quite as desirable as the investigation of quick reconcilia- 
tions recommended above, would be a study of the married life from 
the point of view of the community of several hundred families in 
which a forced marriage had been brought about through the urg- 
ing of relatives, the church, the court, or those social workers, now 
diminishing in numbers, who still beUeve that to legitimatize the 
child and to "give the girl a name" are desiderata sufficiently im- 
portant to justify forcing together against their inclination the pro- 
spective parents of more children. 

In the treatment of desertion and similar problems the sex 
factor is, of course, an extremely important one. The tendency of 
most social workers is either to ignore this as largely as possible or 
to theorize about it to such an extent that it serves, as with the 
Freudians, for an explanation for every phase of human behavior. 

'See questionnaire on The Deserted Family, "Social Diagnosis, " by M. E. 
Richmond, p. 396. 



Desertion and Non-Support 97 

It is on the whole safer to embrace the first alternative than the 
second, but the best work in the.handling of desertion cases will be 
done by the person who neither shuts his eyes to this phase of the 
matter nor unduly emphasizes it. The majority of social case 
workers are unmarried women under forty, and in this particular 
respect they frequentlyfind themselves handicapped by the natural 
reluctance of the deserter to discuss his conception of the marital 
relation in such a way as to be enhghtening to them, as well as by 
the chivalrous attitude which the married woman of the tenements 
often adopts toward her unmarried visitor. The decisive statement 
"You have never been married so you cannot understand" often 
proves at least a temporary barrier in dealing with deserted wives 
just as the similar statement "You have never been a mother so 
you cannot know the feeUngs of one" is used to block her efforts in 
another direction. If it is found impossible to carry on the neces- 
sarj' discussions rationally and without too serious embarrassment, 
it is often possible to call upon the socially-minded physician or 
clergyman for help along this line. 

This, of course, presupposes that the man in the case has been 
located and can be interviewed; but the fact that in the majority 
of cases of desertion this cannot be attained without great difficulty 
is in itself the most serious handicap which the case worker meets 
in the treatment of desertion. In the location of absconding hus- 
bands undoubtedly the greatest single contribution has been that 
made by the National Desertion Bureau, a private organization 
which speciahzes in the location of deserters of the Jewish faith. 
Its use of widespread newspaper publicity, including the publishing 
of photographs of missing men, has been widely imitated by other 
social agencies. In locating absconding husbands it is more than 
usually important to learn accurately facts concerning their trade 
connections, membership in social organizations, employment 
records, etc. Foreign language newspapers are usually willing to 
print personal inquiries, or even photographs, and trade journals 
have been successfully employed in the location of even non-union 
men connected with the trades. The Post Office Department, if 
convinced that the public welfare demands it, might be induced to 
entrust reputable social agencies with forwarding addresses. If the 
husband has deserted for financial reasons, or has left home as the 
result of a quarrel, his location is a much easier matter than if there 

s 



98 The Annals op the American Academy 

is reason to believe he has absconded with another woman. Al- 
though the clues are in this instance doubled since two persons are 
involved, the pains taken to elude detection are usually greater. 

Under ideal police conditions all this ground work of tracing 
deserters could be done by detectives, who already secure from the 
post office and all the other sources mentioned, information that 
furnishes clues. After the man is located through cooperation 
between the detective bureau and the case worker in charge the 
man can be interviewed by her or her correspondent. 

In the attempt of social workers to locate missing husbands they 
are somewhat at a disadvantage. The general tendency to believe 
that the man is invariably in the wrong, and the policy. of arresting 
him first and perhaps letting him explain afterwards, make even a 
man who has a good deal of excuse to offer for his course, reluctant 
to permit himself to be communicated with. Case workers are now 
beginning seriously to question whether in the long run the best 
policy is not after all to interview the man, or to have him inter- 
viewed and to give him an opportunity to state his side of the case 
before causing a warrant for his arrest to be taken out. The at- 
tempt to do this will sometimes result in a second disappearance, 
but if the man's return can be accompUshed voluntarily there is 
many times the basis upon which to build. The deserter, or at 
least the first-time deserter, must not be prejudged without a 
hearing. In spite of the discouraging average of desertion cases, 
this particular man may not be in the average class, and in that case 
it would spell injustice both to him and to his family to treat him as 
though he were. 

Some years ago a charity organization society, which main- 
tained a special bureau for the treatment of desertion cases, was 
asked by a Mrs. Clara WiUiams to help her find her husband, John, 
who had left her some years previously and was living with another 
woman, so that she might force him to contribute to the support of 
herself and her two children. Mrs. Williams- was a motherly appear- 
ing person who kept a clean, neat homo", and seemed to take excellent 
care of her children. She was voluable concerning her husband's 
misdeeds and very hitter toward him, which seemed only natural. 
The fact of the other household was corroborated from other sources, 
and Mr. Williams' work references indicated that he had been quar- 
' These names nrf fictitious. 



Desertion and Non-Support 99 

relsome and difficult for his employers to get along with, although a 
competent workman. The problem seemed to the desertion agent 
a perfectly clear and uncomplicated one and he proceeded to handle 
it according to the formula. Some very clever detective work fol- 
lowed, in the course of which the man was traced from one suburban 
city to another, and his present place of employment found in the 
city where his wife lived, although he lived in another state. The 
warrant was served upon the man as he stepped from the train on 
his way to work, and he appeared in domestic relations court. He 
did not deny the desertion but made some attempt to bring counter 
charges against his wife. When questioned about his present mode 
of living he became silent and refused to testify further. He was 
placed under bond, which was furnished by the relatives of the 
woman with whom he was living, to pay his wife $6.00 a week. No 
probation was thought necessary and the case was closed, both the 
court and the charity organization society crediting themselves 
with a case successfully handled and terminated. 

About a year later Mrs. Williams again applied, stating that her 
husband's bond had lapsed, that his payments had ceased, and that 
she had no knowledge of his whereabouts. Although her home and 
children were still immaculate she failed to satisfy the social worker 
who this time visited her home with the plausible statements which 
she had made before. The children's health was not good and they 
seemed unnaturally repressed and unhappy. Ugly reports con- 
cerning Mrs. Williams' drinldng habits came to the society. The 
school teacher deplored the effect which the morbid nature of Mrs. 
Williams was having on her youngest child, a daughter just entering 
adolescence. The son, a boy a little older, was listless and unsatis- 
factory at his work, and defiant and secretive toward any attempt 
to get to know him better. He spent many nights away from home 
and was evidently not on good terms with his mother. As soon as 
Mrs. Williams saw that real information was desired she began 
indulging in fits of rage in which she displayed such an exaggerated 
ego as to cause some doubts as to her mentality. Baffled at every 
turn the case worker decided to see the man, if possible, and have a 
long talk with him to see if thi-ough him any clue to the situation 
might be gained. The first step was to gain the confidence of a 
former fellow-worlonan and friend of his who now maintained liis 
own small shop. This was done" after several visits, and upon the 



100 The Annals of the American Academy 

social worker's solemn promise "not to have a policeman hidden 
behind a tree" the deserting husband consented to an evening meet- 
ing in his friend's shop. A most illuminating interview followed. 
Mr. Williams was found to be an intelligent though melancholj^ and 
self-centered man. The couple had married somewhat late in life, 
it being Mrs. Williams' second marriage. She had been strongly 
influenced by her mother to marry him and had never had any real 
affection for him. It became very evident from his story that the 
strongly developed egotism of both the husband and wife had made 
a real marriage impossible between them, and the visitor became 
convinced of the genuineness of Mr. Williams' protestations that 
he endured the constant abuse and ill-treatment of his wife as long 
as it had been possible to do so. As her drinking habits took more 
hold upon her and he had realized that the break was coming he 
had endeavored to place the children in homes, and had once had 
his wife taken into court where her plausible story and good appear- 
ance resulted in the case being dismissed with a reprimand to the 
husban4. He then left home but continued to send her money at 
intervals, although as he got older he was able to earn less at his 
trade. SociaUsm was his rehgion, and it was his preaching of this 
doctrine in season and but to his fellow-workmen which had earned 
him the ill-will of his employers. He defended his present mode of 
living vigorously, putting up a strong argument that it was a real 
marriage, whereas the other had only been a sham. He spoke in 
terms of affection of the woman who was giving him the only real 
home he had ever known, and only wished that the state of public 
opinion would permit his taking his young daughter into his home. 
The boy, he reaUzed, had grown entirely away from him and they 
could never mean anything to each other. It was his habit to make 
frequent trips back to the region where his family Uved in order 
that he might stand on the corner and watch his children go by. 
He gave readily much information about his own and his wife's 
past connections, including the addresses of many of her relatives 
whose existence she had denied, and he successfully proved that her 
claims as to his lapsed payments were false by producing the entire 
series of post office receipts covering his remittances to her and ex- 
tending down to the very week of the interview. 

It is true that this is not a " typical desertion case" such as Miss 
Brandt describes in her study of deserted women, but is it not 



Desertion and Non-Support 101 

equally true that the handling of this one case problem according to 
legalistic and juridical formulae meant a real miscarriage of justice 
and the possible sending to shipwreck of two young lives to follow 
the old? It is experiences such as these which have confirmed in 
the case worker a determination to avoid formulae and to treat 
each case problem, in so far as possible, as something entirely new. 

Desertion in Relation to the Community 

It must not be denied that there is basis for the contention that 
just as a community can regulate its own death rate within limits, 
so it can by repressive measures regulate its desertion rate. The 
sort of prevention, however, that keeps the would-be deserter in the 
home which constantly grows less of a home, simply through fear of 
the consequences if he left it, hardly seems so desirable from the 
social point of view as that form of prevention which would provide 
fox such homes and families the wise, skilled and sympathetic treat- 
. ment which is the ideal of social case work. There are no figures to 
show that either method has been sufficiently brought into play in 
any one community to bring about any marked change in the num- 
ber of desertions. Dr. Eubank, in preparation for his pamphlet, 
circularized charity organization societies in a number of cities and 
got widely different opinions as to whether desertion was on the 
decrease, was stationary, or was on the increase. These were 
merely opinions and not the result of statistical studies. In New 
York City, Dr. Devine made a study of five thousand cases known to 
the Charity Organization Society in the years 1906 to 1908 and of 
this number exactly 10 per cent were deserted wives. Ten years 
later, in 1916, a somewhat similar study was made of three thousand 
families known to the same society in the course of that year. The 
percentage of deserted wives was found to be almost the same, 
namely 9.9 pfer cent. The statistics of the New York Charity 
Organization Society for the last year show 492 deserted wives out 
of 4,204, or about 11.7 per cent. This nearly stationary percentage 
over the eleven-year period is probably only a coincidence as these 
particular ten years have seen marked population changes as well as 
the establishment in the city of a Domestic Relations Court, the 
Bureau of Domestic Relations and the National Desertion Bureau. 
It may, however, be taken to indicate that the type of desertion 
which leads to dependency is not markedly on the increase. 



102 The Annals of the American Academy 

Echoes which have reached us already from Europe point to 
great and sweeping changes in the conceptions of family life which 
are likely to result from the great war. .Inevitably our own stand- 
ards must be affected since we are learning that not only in a polit- 
ical sense is it true that the lives of all the nations are one. Home 
Service workers are recognizing that no small part of their task is 
to help keep strong and firm the bonds which bind the soldier on 
another continent to his family on this. Perhaps never before has 
there been the need for careful study and alert watchfulness on the 
part of the social workers in this country, so that the changes which 
come are not unanticipated. No one group in the community, 
surely, is in better position to bear testimony as to the strength 
and weakness of family life, the changing conceptions regarding it, 
and the strains and stresses from which it may still be protected. 



THE ILLEGITIMATE FAMILY 

By Amey Eaton Watson, 
Chairman, Philadelphia Conference on Parenthood. 

In the following discussion, the phrase "the illegitimate family" 
is used deliberately. Hitherto our attention has been very largely 
confined to the illegitimate child and its mother and we have ignored 
the fact that there is in every case a. family involved, father, mother 
and child or children, and that they must all be considered before 
any adequate plan can be made with them. True as it is that in the 
eyes of the state no family has been formed, yet" it is equally true 
that biologically the child has a father as well as a mother and it is 
being realized more and more clearly that socially too the child has a 
father with definite responsibilities and privileges. 

This point of view goes hand in hand with the scientific attitude 
toward the illegitimate mother which instead of destructively con- 
demning or scorning any woman who has brought a child into the 
world without the legal sanction of her group, rather seeks to under- 
stand the underlying causes of heredity and environment which 
have brought her (and likewise the father of her child) to the illegal 
conduct in question. Illegitimacy is the result of biological, psycho- 
logical and social causes following definite scientific laws and there is 
a responsibility of the community as well as of the individual for its 
occurrence. So firmly has this point of view become fixed in our 
thinking since Leffingwell's consideration of it in 1892 that there 
would be no value in emphasizing it here, did we not find the old 
point of view lurking in the otherwise excellent "Questionnaire 
Regarding an Unmarried Mother," by Mrs., Ada Eliot Shefiield.^ 
Here the term "her shame" would seem to indicate on the part of 
even our most advanced thinkers in this field an occasional lapse to 
the less scientific and more inhuman attitude of condemnation and 
reproach. "Moral indignation," says Mr. Britling, "is the mother 
of most of the cruelty in the world, " and J. Prentice Murphy voiced 
this thought at the National Conference of Social Work in Pitts- 
burgh when he said "Much of what we have done and are doing 

'M. E. Richmond, "Social Diagnosis," p. 414. 

103 



104 The Annals of the American Academt 

for the unmarried mother in contrast with other mothers is steeped 
and saturated in a superheated, emotional, pseudo-moral atmos- 
phere and I submit to you the observation that no such atmosphere 
can really make for helpfulness."^ 

While this point of view has taken a firm hold of our thinking, 
it is only just being applied to our case work with the illegitimate 
family, which is still decidedly in the experimental stage. Case 
work with the illegitimat'5' family is seeking to work out principles 
whereby the interests of the illegitimate child and those of both its 
father and mother may be harmonized with the best interests of 
society. This end will be secured when the responsibiUty for the 
illegitimate child is more evenly shared by the father and mother 
as well as by the state. The Castberg law of Norway is being 
watched with great interest by social case workers as probably the 
most advanced experimentation in this field, inasmuch as it gives to 
the illegitimate child among other things the right of paternal in- 
heritance, of paternal name and of the standard of Ufe of that parent 
which is better situated. The Minnesota Children's Code is also 
advanced in that it makes the state the ultimate guardian of all its 
disadvantaged children, including the illegitimate, and therefore it 
is the work of the State Board of Control to institute proceedings to 
establish paternity or to see that such proceedings are instituted, as 
well as to seek in other ways to secure for the illegitimate child the 
nearest possible approximation to the care, support and education 
that he would be entitled to if born of lawful marriage. Further and 
better standards of case work in this field must be established by 
studying experimentally the question of removing the evil effects of 
the stigma in illegitimacy. Only injustice is done in allowing this 
to attach to an innocent child and we must get evidence to show us 
when the welfare of society is furthered by having a stigma placed 
on one or both parents. Above all, in line with the findings of 
modern criminology, emphUsis must be placed upon the reeducation 
of the individuals involved, not upon either punishment or stigma. 

Information Needed 

In gaining the necessary information for a diagnosis in working 
with any illegitimate family, the case worker, utilizing the same 
sources of information as worked out for all forms of social diagnosis, 

' From an unpublished paper. 



The Illegitimate Family 105 

must exercise the greatest tact and consideration. She must make 
unusual efforts to gain the friendship and confidence of the inother; 
on account of pubhc opinion, the chent has undoubtedly been put 
on her guard, feeUng that everyone is against her. Sympathy and 
understanding are needed to win her and for these reasons it follows 
that investigation must be gradual. In some cases it will be nec- 
essary to find out the most intimate facts of any individual's life, 
facts which it is often not necessary to inquire into in any other kind 
of case work. This is all the more reason for going slowly and care- 
fully with deep consideration and with a realization that harm may 
be done if the client feels that she is being probed or that she is being 
forced to reveal information which may be used against her or against 
the father of her child. It must also be realized that many girls 
may become morbid and an effort must be made to keep their minds 
off their experiences rather than to allow them to dwell on them. It 
is vital that our investigation should be thorough, tapping every re- 
source. Failure to learn all possible facts at the proper moment 
has undone years of effort. The writer calls to mind a case which 
had been handled by a relief agency with high standards over a 
period of seven years during all of which time it was taken for 
granted that the man and woman were legally married and it was 
only at the end of this time when an illegitimate child was born to 
the daughter of the family by her supposed step-father that it was 
discovered that he was not her step-father and had never been mar- 
Tied to her mother. Had this been known earlier, precautions could 
have been taken to protect this girl and this case of illegitimacy 
might have been prevented. It is particularly important that in all 
■case work marriage and birth records should be consulted among 
the first sources of information; they involve the telling, of no se- 
crets, are entirely trustworthy and should never be neglected. 

It is hoped the following outline for a minimum investigation 
may be suggestive:' 

' The Boston Conference on Illegitimacy has also worked out a minimum in- 
ve"stigation which may be obtained from the President, Miss Mary Byers Smith, 
Andover, Mass. An outline for a maximum investigation has been worked out by 
the Inter-City Committee of the Boston Conference. See also Questionnaire by 
Mrs. Ada Eliot Sheffield in "Social Diagnosis" by M. E. Richmond, p. 414, re- 
ferred to above. 



106 . The Annals op the American Academy 

I. The Girl or Woman 

1. Her family 

a. Heredity and health of family 

b. Social history of family 

(1) Occupations 

(2) Earnings 

(3) Marital history 

(4) Type of family life, including size of family, education of 

both parents, religion, etc. 

(5) Boarders, lodgers, etc. 

(6) Relatives other than immediate family 

2. Her general history 

a. Date of birth. 

b. Place of birth 

c. Race 

d. Residence 

e. Civil condition 

f . Marital history and composition of family, if any 

3. Her health 

a. Past history 

b. Present condition 

(1) Doctor's examination 

(2) Wasserman or other test if advised 

4. Education and mentality 

a. Length of time in school 

b. Age, grade and reason for leaving 

c. Vocational or other training 

d. Mental examination 

5. Occupational history 

a. Occupations and how long held 

b. Earnings in each 

c. Capability as learned from teachers, employers and others 

6. Recreation 

a. Kinds and extent 

b. How supervised 

7. Religion 

a. Church connections, their extent, duration and influence 

8. Sex life 

a. Was her adolescence normal? 

b. Was she ever given instruction in matters of sex and if so, by 

whom and when? 

c. What has been lior sex experience, including her relations with 

the father of her child? 



The Illegitimate Family 107 

9. Other facts 

a. Age at leaving home, reasons and conditions under which she 

has since lived 

b. Court record 

c. Institutional record 

d. Known to other agencies 

10. Relations to child 

a. Ability to care for child 

b. Desire to care for child 

II. The man 

All of the above facts, with special emphasis on marital history, com- 
position of family if any, and economic capacity 

III. The Child 

1. Date of birth 

2. Place of birth 

3. Physical condition 

a. Doctor's examination 

4. Dispositions 

5. Mentality as soon as child is old enough for this to be ascertained 

In making our inferences from the facts which have been learned 
by the investigation, great precautions must be taken. In the field 
of sex there is much prejudice and likewise much that is pathological. 
We must utilize the help of experts wherever possible.^ 

"And a little child shall lead them." In our work with the 
illegitimate family, our strongest ally is the child. How frequent it 
is mTh& experience of every social worker that while during the 
pregnancy of an illegitimate mother, everyone turns against her, 
when the child comes, it makes an irresistible appeal and wins its 
own way into the hearts of those who should care for and protect it. 
Therefore our first effort should be to give the child every oppor- 
tunity to be seen and loved and cherished, first by its mother, then 
by its father and. lastly by its other relatives. 

Removing the Child's Handicap 

After all it is the child that is our real interest and it is his or her 
welfare that we are most vitally interested in securing. We have 
emphasized above that the illegitimate family is a unit and as social 
workers we consider all the members together. This does not 

* See Chapters IV and V of "Social Diagnosis" by M. E. Richmond; also Will- 
iam Healy, "Mental Conflicts and Misconduct." 



108 The Annals of the Ameeican Academy 

vitiate the fact that the welfare of the child is supreme and that we 
work for the welfare of the father and mother largely in order that 
we may do our utmost for the child. This plastic little creature, 
full of possibilities, must have its future safeguarded; we must seek 
to give him or her the best possible nurture and support, as nearly as 
possible as if he had been born in wedlock.. It is our privilege and 
our problem to see how we can conquer social conditions so that he 
will be handicapped as little as is humanly possible. How shall we 
accomplish this result? 

We mus{ take into account the character and potentialities of 
both parents, arousing them if possible to make a ^lan of their own. 
We must meet them on their own level, working with them in order 
that they may understand their own problems and develop their 
own resources and character to meet their situation. It has been 
pointed out that we must remember that the father as well as the 
mother may be in vital need of our help, that he too may be passing 
through a moral and spiritual crisis needing friendship and guidance. 
Above all we should not make a plan for our clients and seek to 
force it upon them regardless of their cooperation.- Such work is 
pedagogically unsound in that it fails to arouse the individuals to 
self-help and independence. 

Having eliminated the idea of punishment, we shall trj- to 
arouse in both parents a love for and a responsibility for the child. 
We shall help the mother to get away from a sense of shame and 
arouse pride and joy in the life of the child; we shall try to inspire 
or liberate the father's protective instinct toward his child, arousing 
any paternal feelings that he may have. We shall reconcile out of 
court whenever possible, first considering marriage (if both the man 
and woman are unmarried). This however must never be forced. 
When in such cases there is genuine affection or respect between 
both parents or when in both a real affection for or interest in the 
child appears, then marriage may be the best solution if both parents 
so decide. If marriage is not the best solution, then seek to arrange 
voluntary agreements, legally sound but out of court, thus doing 
away with the undesirable publicity which has to occur even in our 
best courts. Such voluntary agreements out of court should not be 
accepted if the amount agreed upon is much less than it would be 
if the case were won in court. 

As a last resort the majority of cases should be taken to court, 



The Illegitimate Family 109 

the paternity of the child established and a court order placed upon 
the man. It is remarkable in how many cases the self-respect of a 
girl is increased when the paternity of her child is established. 
This must be done also because every illegitimate child has a right 
to know who its father is. Are we not in this country beginning to 
feel that the Norwegian ideal of securing support in every case is 
practicable and desirable or at least that it should be secured far 
more generally than it now is? This means that better court meth- 
ods and more humane ways of dealing with the mother will have to 
be devised and also better machinery for enforcing the orders which 
many of our courts are placing upon many fathers of illegitimate 
children. The amount of these court orders will inevitably be in- 
creased, especially in the case of any men who are economically well 
off and in such cases the period over which such orders shall be paid 
will undoubtedly continue to increase. In all of these court orders 
we must differentiate between the just claim of society for the eco- 
nomic support of the child by its father and the questionable claim 
of the mother for damage done her or the equally questionable claim 
of society for punishment of the individual man for violating its moral 
code. Economic support from the man (as well as from the woman) 
is to be enforced, for failure to support any child is a crime which 
the state cannot tolerate for its own well-being. 

Individualization of Treatment 

So far in our discussion of treatment, we have failed to stress a 
principle of case work which is as vital in work with the illegitimate 
family as it is with the legitimate. This principle is individualiza- 
tion of treatment. The day is past when all illegitimate mothers 
were sent to a rescue home as they were considered to need moral 
reformation to atone for the sin they had committed. It is still 
true, however, "that there are few tasks requiring more individuali- 
zation and there are few in which has been so little."^ Indi- 
vidual differences are the basis of social life. So complex is human 
nature, so varying are the threads that combine to make up an 
individual lifg'that in no two cases will our diagnosis be the same and 
in no two cases will our treatment be identical. One test of good case 
work with this group as with any other is the ability to be flexible, to 
adjust ourselves to the changing needs of the individuals whom we 

5 M. E. Richmond, "Social Diagnosis," p. 413. 



110 The Annals of the American Academy 

are to help. This being so, we must hesitate to lump any of these 
groups into classes or a series of classes. The affixing of a label may 
apparently simplify our work, and we yearn for simplification in a 
fijeld so fraught with difficulties. We therefore question the classi- 
fication Mr. Carstens made in his discussion at the National Con- 
ference at Pittsburgh when he divided illegitimate mothers into three 
classes, the good, the vidous and the defective. It is true of course 
that those illegitimate mothers who are diagnosed as feeble-minded 
by a psychologist do constitute a group by themselves. This, how- 
ever, is the only group thp,t can be scientifically measured off, and 
even within this group we must to a certain extent apply the prin- 
ciple of individuaUzation of treatment. In the main the dangers of 
classification more than offset the advantages. 

From the first, it is vital that the health of the mother and 
baby be protected. The infant mortaUty of illegitimate babies is 
three times that of legitimate. For this reason we must encourage 
the illegitimate mother to seek medical advice as soon as possible 
after conception and to continue it regularly during pregnancy and 
after the birth of her child. For this reason as well as for others 
some social agency should continue care of both mother and baby 
as long as possible. Under the Minnesota Children's Code, the State 
Board of Control may offer to the unmarried woman about to be- 
come a mother its aid and protection even before the birth of her 
child and it is further provided that where a woman is received in a 
hospital expecting the maternity of an illegitimate child, the person 
in control shall at once notify the State Board of Control. In other 
places where there is no such provision, it is disputed whether one 
central agency should handle all the cases of this kind or whether 
those agencies that naturally first come into contact with them 
should continue their care. Some hospitals are doing unusual work 
with this type of case, e.g., the Social Service Department of the 
Massachusetts General Hospital which works with the mother a 
long time before the birth of the child, endeavoring to instill in her 
an interest in keeping the child when it is born, preparing her mind 
and her mode of life. 

It seems vital in the majority of cases to keep the mother and 
child together at least for the first six months of the child's life, when 
the mother should be helped to nurse the baby. Nursing a child 
successfully, however, is so largely a psychological matter that it is 



The Illegitimate Family 111 

not enough merely to keep mother and child together but we must so 
place the mother that she may have the maximum of content as well 
as of physical well-being. One questions whether a mother can be 
forced to nurse her child. Should we not rather bring her to see it 
as a joy and a privilege in order to safeguard her baby's life? The 
problem of supplying work for her at this time is a difficult one. In 
some cases it is possible for the mother to act as wet-nurse to other 
children and thus to support herself and her child. Some maternity 
hospitals are keeping the mother in the hospital long enough to 
train her in some form of employment and to assist her in securing 
the same, allowing her to live in the hospital and to keep her child 
there while she begins her work. 

Permanent Work for the Mother 

The problem of the best regular work for the mother after the 
nursing period is a pressing one." In the past, domestic service has 
been the usual solution. Domestic service, however, supplies more 
illegitimate mothers than any other occupation. Is this not because 
domestic service is the most unstandardized of all types of work? 
Its hours of work are excessive, there is little opportunity for rec- 
reation or normal companionship and it is an occupation that is con- 
sidered menial by the average person of intelligence, with the conse- 
quence that the most unskilled workers enter this field. If domestic 
service seems the occupation. fitted to a given individual's tastes and 
abilities, should we not seek to give them training first in this field 
and then to find them opportunities to work with employers who 
will understand their need of a sane, wholesome life, including 
standardized hours, recreation and companionship? The problem 
of recreation and social life for the domestic employe is one which 
intelligent women must solve. Until we can find more socially 
minded employers, should we not hesitate to place, illegitimate 
mothers at domestic service but rather seek to find other types of 
employment fitted to the individual's capacity and training? How 
the mother is to do various types of work and still keep her child is a 
problem. 

The ideal solution is where the mother can live in her own paren- 
tal home, doing part time work in the home or going out to work while 
some member of her own family looks after her child. If this is not 
possible, it is sometimes feasible to find a boarding home where the 



112 The Annals of the American Academy 

mother may live with her child, going; out to work by the day and 
leaving her child in the care of the woman with whom she is boarding 
who may herself be the mother of small children. The more normal 
such a home life, the better for our client and for the child. What- 
ever work is found should be interesting, with adequate remunera- 
tion and allowing some chance for advancement. Wherever pos- 
sible an effort should be made to secure funds either from relatives 
or from scholarships to give the mother vocational training to equip 
her for a more highly skilled and more interesting type of work 

A Normal Life foe the Mother 

Above all we should aim in treatment to reinstate the mother in 
normal life, that is, to place her in such a way that in addition to 
interesting, remunerative work, she will have normal social contacts, 
companionship with others of her own age, if possible of both sexes 
under supervision. She needs wholesome recreation supplied to 
her through clubs, in settlements or church or trade union groups. 
She needs to feel herself a personahty with possibihties of life ahead. 
And all of the above must be suppUed to the child as he grows up. 
In, addition we must seek to make for both mother and child the 
normal reUgious contacts, helping the mother to find her place in her 
church group if she at one time belonged or, if not, opening up this 
possibility for her in whatever way may best fill her need. For both 
mother and child strength from this source may do much in helping 
them to facethe extreme difficulties of their lives which we at best 
can but soften. 

If the above conditions can be fulfilled and the mother and child 
can be kept together, there must be a gain for both. The relation 
of parent and child when it really exists is basic and is one which 
should never be broken until every effort has been made to strengthen 
it and test out its reality. The child needs the family life and ties 
and the mother needs the child. Yet, as in the case of marriage, we 
should not force the external living together if it is only the shell of 
the relationship which is existing. Keep mother and child together, 
then, if the mother is fitted to give physical, mental, moral and at 
least part of the financial care to her child and to be happy in doing 
it. Under such conditions it would seem as if no other plan could 
so securely safeguard the child's future. If, however, the mother is 
not fitted to give such care to the child, and cannot be trained for 



The Illegitimate Family 113 

it while the child is with her, it seems unwise to keep mother and 
child together. Perhaps a temporary separation may be the solu- 
tion, in order that the mother may be trained for more adequate 
parenthood in the future. If she is incapable of being trained under 
any circumstances, it seems clear that a plan should be made for the 
child away from its mother, with her relatives if possible, with the 
father or the father's relatives or in some other situation where it 
will have as nearly as possible normal home life. In the case of a 
defective mother the baby should be separated from her just as soon 
after birth as the physician deems wise. 

In cases where there is no relative who can adequately care for 
the child, we are faced with the question of adoption. In this vol- 
ume of The Annals J. Prentice Murphy has outlined certain ques- 
tions which must be answered before the legal adoption of any child 
is arranged for.^ We must stress the fact that this should never 
be encouraged until we know all the, facts about the child's own 
parents and relatives and are reasonably sure that they can never 
offer it a suitable home. The writer has in mind a case where a 
social service worker made only a cursory examination into a child's 
home situation before securing its adoption by a wealthy doctor. 
At the time she thought that the father had deserted and she knew 
nothing of the possibilities of his returning and the family being 
restored to normal life. Although it later turned out that the child 
was illegitimate, it was by no means clear that the child's own rel- 
atives could not have cared for it adequately. Untold harm may 
be done in this way. Another aspect of the matter that should be 
considered is that, of disease and heredity. No child, that is of dis- 
eased and no child of feeble-minded parents should be placed in any 
home for adoption until the foster parents know the full facts of the 
case and are ready to take every precaution to see that the disease 
is not passed on to others and that later in life the defective germ- 
plasm is not mated with normal stock, thereby passing on the defect 
and causing much preventable misery. 

Dealing with the Illegitimate Family 

Should case work with the illegitimate family be conditioned 
by exactly the same considerations as case work with the legitimate 

' See his article in this volume on "The Foster Care of Neglected and De- 
pendent Children." 



114 The Annals of the American Academy 

family? This question has been variously answered : in one way in a 
paper at the recent National Conference in Pittsburgh, and in various 
ways by the different conferences on illegitimacy in their more inti- 
mate councils. Our answer is that it both should and should not be. 
In the main "the methods and aims of social work are or should be 
the same in every type of service. ' ' ' The individuals constituting the 
illegitimate family do not necessarily differ in any wise in physique, 
character or ability from those constituting the legitimate family.' 
The principle of individualization of treatment applies equally in our 
work with both groups. There is, however, one factor which is pres- 
ent in every case of illegitimacy which in the opinion of the writer 
inevitably affects our case work with this group. That fact is that 
the man and the woman have both broken the law or the "mores" 
of the larger social group in which they live. It is true that the 
laws concerning illegitimacy have varied in a most interesting way 
as we follow down the pages of history, but failure to conform is a 
distinct social phenomena which must be studied. Therefore in 
every case of illegitimacy we have as added consideration to study, 
i.e., why did both the father and mother break the law and bring a 
child into the world without the legal sanction of their group? In 
the widowed group the specific maladjustment which brings the 
woman to our attention is of a different kind; in the deserted wife 
group the man and woman have followed the law at least to the 
extent of legally forming their family and the man has given the 
woman and child his protection for at least a period. In the illegit- 
imate family the psychological attitude of both the man and the 
woman will inevitably reflect the fact that they have broken the 
law and we must understand in just what way this is so. 

In the second place, case work with the illegitimate family will 
be conditioned by different considerations than that with the legit- 
imate family group in that treatment with the illegitimate mother 
must always bear in mind and depend upon what society's attitude 
is toward the girl. Public opinion is such a stiong force and can 
punish so severely those whom it condemns that we must leekon 

' M. E. Richmond, "Social Diagnosis,'' p. ii. 

' Undoubtedly u certain percnitngc of unnuirried mothers are feeble-minded 
but this is also true of married mothers. There are probal)l.\- more feeble-minded 
among the illegitinmto mothers tiian among tlic legitimate but this tells us nothing 
concerning any individual in either class. 



The lLLEGiTiM.iTE Familt 115 

with it, no matter how unjust we may consider its decisions to be. 
This is well illustrated by the ease of Mrs. B, a widow with five 
children whom a relief agency had been assisting since the death of 
her hiisband. When calling on the undertaker to learn the number 
of her husband's grave, he assaulted her with the result that she 
became pregnant. From previous experience with this woman and 
from all that could be learned, she was entirely innocent of any 
wrong, but the problem that faced the case workers was inevitably 
very different from that which would have faced them under any 
other conditions. The coming child had been conceived contrary to 
the laws of society and pubUc opinion must be reckoned with in our 
work with this mother, with her child and with its father. The 
social case worker in this case has a definite responsibiUty thrust 
upon her to educate pubUc opinion by her case work to a more just 
attitude. It may be a great temptation to do the easy thing, to 
help the mother move to a different locahty and to start life afresh, 
but two conferences which deUberated long and carefully on this 
case felt that such a plan would be cowardly and that it was a defi- 
nite responsibility to help the mother through her confinement 
and to return her to the community in which she Uved. Then with 
economic help from the father of her child, as well as from the social 
agency, she could show that the mother of an illegitimate child can 
be worthy of confidence and can in every sense of the term be a good 
mother to her illegitimate child as well as to her legitimate children-. 

Social case workers then who are working with the illegitimate 
family must do much hard and careful thinking. They must have 
in mind the historical development of the family, must be in touch 
with the findings of modern criminology and above all, must have 
courage and sympathy to work with their cUents, on the one hand 
reeducating them and, on the other, reeducating pubUc opinion. 
The maladjustment which results in the problem of the illegitimate 
family is part of our evolving standards of family life. 

May we not therefore emphasize the need of a higher concep- 
tion of parenthood and of family life as a means of preventing this 
very evil? The maladjustment which resulted in the birth of an 
illegitimate child came partly at least through ignorance or the 
failure to reaUze the wonderful responsibilitj'^ and great possibilities 
of sex in its finest sense. We must see that the right kind of sex 
education is given to the illegitimate child in its turn in order that 



116 The Annals of the American Academy 

he may see the full measure of his possibilities. But if our case 
work is to be truly sound, we cannot stop by applying this only to 
the illegitimate child but we will do all in our power to supply every 
child with a sound foundation in health, vocational education, nor- 
mal social contacts and recreation, and, above all, to give it the 
vision of what life may mean when every individual man and woman 
keeps sacred and untouched this creative power of sex until its 
exercise will bring only joy to the individual and welfare to society. 



THE FOSTER CARE OF NEGLECTED AND DEPENDENT 

CHILDREN 

By J. Prentice Murphy, 
General Secretary, Boston Children's Aid Society. 

More than fifty years of controversy on the part of children's 
workers as to which offers the better care,— the family or the institu- 
tion, — would never have taken place if all the parties interested had 
enjoyed a common understanding of the significance of what the 
modern social worker calls case work, that elastic, imagiaative, 
penetrating understanding of each individual in need, that process 
of interpretation that never looks upon the individual as a solitary, 
isolated being, but as very closely related to many people and 
things and difficult to Understand. 

Most of the workers engaged in the children's field of service 
have for years past developed systems of care and methods of treat- 
ment which they felt were indisputably right. One of the interest- 
ing developments of a good case work job is the discovery that it 
becomes increasingly difficult to classify rigidly the children or 
people you study. One child will be considered by an ineffective 
social worker as dependent^but by a much more skilled worker as 
representing a variety of conditions other than dependency. There 
are copious illustrations along this line in society's treatment of 
adult delinquents. The more we know of the conditions causing 
crime, the more do we understand that pure delinquency as such 
is a very rare condition in any individual's life. Just so we discover 
through case work that pure dependency and pure neglect are equally 
rare conditions in the lives of children. They may be neglected ; they 
may be in need of foster care; but they are also a series of different 
entities, some intelligent, some unintelUgent, some capable of great 
growth, others not, some well, some sick, some properly trained, 
many improperly trained, some in need of a certain special indi- 
vidual touch, others equally in need of a radically different over- 
sight and supervision. 

The laboratory method has prevailed less in children's work 
than in most other fields of social work. There has been httle actual 

117 



118 The Annals of the American Academy 

studying of methods and results, little open-mindedness; but on 
the contrary, often a fierce and violent contentiousness on the part 
of advocates, irrespective of the system in question, who were con- 
vinced that those differing from them were entirely in the wrong. 

We are here considering foster care of children who by reason 
of sickness, death, incompetency, improper guardianship or wilful 
neglect on the part of their parents or relatives, must be provided for 
in foster homes. We are not including in this group children whose ■ 
parents are suffering solely from poverty. Such children do not 
properly come within the, scope of an organization giving foster 
care, but fall within the field of organizations giving relief in any 
form or able to advise and otherwise assist in the carrying out of 
plans which relieve the condition of poverty without giving material 
relief. We are not eliminating from this neglected and dependent 
group, children who by reason of the parental treatment they have 
received present special problems in the way of discipline but who 
do not fall within the so-called delinquent class. 

All of the countries of western Europe, and the United States 
and Canada have for two generations been engaged in the process of 
developing certain special methods looking to the best care of chil- 
dren who for any reason must be taken from their own families. 
The time has arrived, however, for a proper understanding of the only 
dependable method of approach to the care and treatment of such 
children. The whole controversy between institutions and agencies 
engaged in children's work and giving different types of care can be 
settled only through the application of good case \york. Only in 
this way can there be carved "out for each child that type of care 
which it most needs, and for each institution or agency that task or 
service which the community where it' operates most needs. 

The introduction of case work has meant the revolution of medi- 
cine and law and is meaning the revolution of social work. Every 
branch of social work which is touched by case work methods, is in 
process of revamping its technique, with such results as make the 
newer type of service a very diiferent thing from the service of even 
a few years ago. The problems of the destitute, of the sick, of the 
insane and mentally defective, of the delinquent, of the dependent, 
are now being expressed in terms of hopefulness and understanding 
such as were almost entirely absent in the past. This case work ap- 
proach to work with children has particular significance because 



Foster Care of Children 119 

children more than any other members of society will most benefit 
from it. 

The approach to any neglected or dependent child, as to any 
other individual, adult or child, should be made only in the spirit 
of understanding his needs, of trying to meet them rather than with 
a feeling that his needs have already been interpreted; that he has 
already been classified; and that rigid and inelastic methods of treat- 
ment are always proper and wise. With such diverse groups of 
children, whose needs arise by reason of certain conditions in their 
own homes, the children's organization must deal, and it must so 
adjust its work as to be able to provide the special and intimate 
service, sympathies and understanding, which are the right of 
every child and without which no child can develop normally. 

It is the task of the social worker to know the children with whom 
he or she is dealing, to see things from their standpoint as much as 
from the standpoint of the adults and others who have affected the 
life of the particular child, and then to try to provide through social 
treatment the essentials which careful study shows the child to have 
lacked. Therefore, every children's organization which expects to 
do an effective, helpful service to the children and to the community 
which it reaches, must be provided workers who are competent 
to understand the social problems which the children present, to 
get their right relationship, and then to apply the most effective 
social treatment. 

This better type of care will in many instances apparently cost 
more than less thorough work, but actually the best and most com- 
plete service to an individual in need, no matter how great the cost, 
is in the end the least expensive. Moreover, on the cost side, the 
war has fastened upon many people of all social positions this one 
great idea; that if so much money can be spent for a special national 
protective work, then with equal justice may society publicly or 
privately spend far larger sums than we have thought advisable in 
the past for the proper care and training of thousands of children 
who through no fault of their own stand in need of development and 
opportunities which their parents cannot or will not give to th^m. 

As has been noted, we are not concerned in this paper with the 
problem of care for children in families where poverty is the chief 
cause of distress. One general principle should control all work for 
children, namely, that the child's own family ties with parents or 



120 The Annals of the American Academy 

other relatives, if it is living with the latter, should be broken only 
as a last resort. Because good case work does not hold with all 
children's agencies, this principle is not observed; action is often taken 
in ignorance of the child's real home conditions and resources, and 
he is injured rather than helped; for foste^ care, although it may- 
be of the best, is nevertheless, in many instances, a poor substitute 
for the care which parents could and would have given if the means, 
opportunities or advice, had been provided. Even applications for 
temporary care of children should be carefully studied because often 
the thing asked for is not what is needed and other than temporary 
care may be necessary and imperative. 

The work of the Bureau of Investigation of the Department of 
Public Charities, New York City, under Commissioner Kingsbury, 
is proof of how more careful case work means the keeping of many 
children with their own people. Fewer children were committed 
by the Department to the children's institutions in New York City 
during the last years of Mr. Kingsbury's term than were committed 
during the term of the previous Commissioner, the decrease being 
the result of a more careful understanding of family problems affect- 
ing thousands of children. 

Case Methods Applied 

Let us apply case methods to the following special problems 
which concern every social worker and especiallj- every children's 
worker. Consider the question of adoptions. A study of the 
reports of certain children's home and children's aid societies and 
certain institutions scattered all over the country, shows a surpris- 
ingly large number of complete adoptions of children for each year 
of their work. A study of the reports of other organizations, often 
in the same localities and usually dealing with the same types of 
children and caring for equally large numbers of children, shows 
almost no adoptions. Why is this so? Careful study leads one to 
feel that the difference is due largely to the lack of adequate case 
treatment on the part of the first class of agencies and to the use of 
good case methods on the part of the second class. 

The case work approach to the adoption problem presents a 
series of very special difficulties. First, the more one studies intake 
(that is, the more one studies the appHcations for care presented by 
parents, relatives, interested friends, and cooperating agencies, 



Foster Care of Children 121 

public and private), the more one finds out that there are relatively- 
few children without some ties of relationship which should be pre- 
served. This holds equally true for the child who is usually adopted 
and for the child who is given long time free home or boarding care, 
either in institutions or families. 

The great majority of children now given for adoption are 
illegitimate children. However, a large number are the children of 
lawfully married people, who for a variety of reasons are wiUing to 
give up their children or to permit their children to be taken from 
them uijder curiously illegal legal agreements entered into with 
the caring agency. 

The well trained social worker will try to preserve for a depend- 
ent or neglected child such ties of relationship as will help it. She 
will also understand that full knowledge about the child she is help- 
ing will inevitably mean better care. 

The adoption of a child should mean the answering of at least 
these questions : 

1. Is an injury being done to its parents or relatives in taking it from them 
or keeping it from them? 

2. Are they quite unable, with proper assistance, to train their own chUd? 

3. Are we certain that the adoption proceedings do not represent an escape 
from proper responsibilities on the part of a parent? 

4. Is the child well physically? Is it well mentally? 

5. Have we fully satisfied ourselves as to why in each particular instance the 
relationship, provided the parents are living, is being severed? 

6. Are we trying where possible to keep alive the relationship between broth- 
ers and sisters, assuming that the child considered for adoption has brothers and 
sisters? 

Our failure as communities to apply case work methods to the 
adoption problem has meant that courts, communities, governing 
bodies and social agencies have quite underestimated the significance 
of their large adoption rates. Social conditions are not right in a 
community that year by year is agreeing to adoptions of large num- 
bers of children. 

Each unmarried mother takes on an entirely new significance if 
we survey the adoption of her child in the manner suggested. The 
maternity homes get into a right relationship to their jobs when case 
work methods are applied. Our failure to apply the case method to 
illegitimacy has meant our failure up until now to get the real signif- 
icance of our illegitimacy situation. Only as innumerable stories 



122 The Annals of the American Academy 

are studied and analysed will we get beyond the stage of simply 
passing out illegitimate babies without knowing exactly why they 
come and how the tragedies back of each little child may largely be 
prevented. 

Careful case work with unmarried mothers shows a high percent- 
age of capable mothers who, if given the opportunity, have training 
possibilities which would benefit their babies. Careful case work 
also shows that many unmarried mothers are feeble-minded or 
suffering from syphilis or gonorrhea, and frequently that babies of 
the latter class suffer from syphilis. How necessary does it become 
to see that babies with this inheritance of feeble-mindedness or 
disease are not placed in families where the opportunities offered 
will be wasted upon them. 

Our tendency to provide foster care for illegitimate children sa 
easily and so constantly, in ignorance of the conditions from which 
the child has' sprung, is evidence of the fact that legal injusticea 
with reference to illegitimate children and social injustices with 
reference to mother and child still persist. 

When each unmarried mother and her child are studied wdth a 
view to their best development, there will be many instances in 
which it would seem wisest to arrange for the adoption of the child, 
and these children will then be most accurately placed in families 
according to their abilities based on physical and mental health. 
More mothers will receive support from the fathers of their babies, 
more mothers will be assisted in getting from the experience of un- 
married motherhood that protection which will help them and their 
children and the state. At the present time the failure to apply 
case work generally to the illegitimacy problem lueans a ruinous 
shifting of responsibilities to other parties who do not always con- 
tinue with them. The best societies for the protection of children 
from cruelty are constantly removing children from adoptive homes 
where conditions of neglect hold, the primary reason for the condi- 
tion of neglect often being due to the fact tliat some agency or person 
at the time of adoption did not know the whole story with reference 
to the child's physical and mental history. 

All students of the problem of child care agree that the normal 
family is the ideal place for .the rearing and training of children. 
This position was emphatically affirmed at the White House Con- 
ference in 1909, and has been constantly reaffirmed since then 



Foster Care of Children 123 

by children's workers of all interests, including institutions and 
placing-out societies. The chief difficulty on the part of the leading 
institution people is their fear that there are not enough good 
families. An adequate understanding of neglected and dependent 
children oh the basis of good case work, prevents one from sajang 
that either. family or institutional care exclusive of the other com- 
pletely meets our needs. However, the more carefully the children's 
organization, whether institution or placing-out society, studies its 
applications in terms of case work, the more constantly does it see 
that it must continuously base its major services on something 
approximating family life. 

It was case work, although this term was not used, that led to 
the development of the cottage type of institution; it was case work 
that drove home the idea that the congregate prison is an evil and 
a terribly injurious institution; it was case work that showed the 
courts that community life and family life may be tried with increas- 
ing numbers of those charged with delinquencies and with helpful 
results; it was case work that carried the hospital contacts from 
bed-side or clinic out into the family and the community; it is case 
work that is making each progressive children's agency see every 
child it receives as having a variety of needs which can best be met by 
family life or its approximation if they are within an institution, and 
that the desirable thing is to strive to transfer the training task as 
rapidly as possible to family centers. 

Thorough case work, as apphed to home-finding or more specif- 
ically the securing of foster family homes for children, is of very 
recent growth. The fact that home-finding methods generally have 
contained so many elements of chance has made many institution 
people feel that good institutional care is a much more certain and 
definite thing to follow. If potential foster homes are studied in 
exactly the same way that other families known to social agencies 
are studied, the element of chance is increasingly eUminated and 
then is there possible that adjusting of particular children to particu- 
lar families which so many of us have talked about and so seldom 
realized. If the home-finding job had always been what some of 
its advocates have said it was, there would be few types of institu- 
tional care in existence. The application of case methods to this 
division- of children's work will effect as great a revolution on the 
home-finding side as on the institutional side. 



124 The Annals of the American Academy 

It is a fact that most families into which neglected and depend- 
ent children finally go for care are selected in a pretty superficial 
way. Even reputable children's agencies which exercise great care 
in determining the children they will receive are content with much 
less thorough service in selecting the foster families to which the 
children are to go. Most well organized cities throughout the 
country now have confidential exchanges and yet it is rare to find 
the children's organizations using these exchanges for their foster 
homes. 

A potential foster home should be studied with the utmost care 
and everyone having important knowledge as to its training ability 
or disability should be searched out. In too many instances work- 
ers are prone to let the question of approval rest on a small fund of 
information furnished by the family plus a few references which they 
have given, and occasionally information from independent sources 
known only to the society. It is no wonder that the most thought- 
ful students believing in the institutional methods — ^who see only the 
work of these agencies — look with questioning on such a procedure. 

Family home work for babies is largely a matter of getting ex- 
pert physical care. Yet an organization paying regard only to the 
physical factors may by reason of faulty work do great injury to the 
unmarried mother of a baby in such a home. One society reported 
the family of a physician who with his wife was able to give most 
intelligent care to certain babies placed with them, and there were 
no difficulties offered until the baby of a young unmarried mother 
was placed in this home. Then the discovery was made that the 
physician was a man of low morals and had gravely tempted the 
girl immediately on his learning that she was unmarried. 

Where famihes are being sought for the foster care of babies, it is 
not necessary to search only for good disciplinarians, or for people of 
unusual education, but the home life must be good, especially where 
there are contacts with unmarried mothers. Often the most 
effective work done is through the foster mother rather than the 
visitor, who is most directly concerned with the supervision of the 
mother and baby. 

For quite a long while a difference of opinion has existed among 
the children's workers most interested in the care of children in fami- 
lies, with regard to the value of free homes as against boarding homes. 
The advocates of the free type of home have contended that they 



Foster Care of Children 125 

used a better type of home than was true of the type largely engaged 
in boarding out. If one approaches the dispute with a view to ascer- 
taining all the facts, or in other words follows the case method, 
certain things- will stand out: first, that free homes are generally 
restricted to very httle children who are without family ties or whose 
family ties can be severed without opposition from parents or others. 
These children are supposedly well and must generally be attractive; 
that is, sick,, diseased or unattractive children do not come within 
this class. Second, older children, generally over twelve, are re- 
ceived into free homes because of certain services they may render. 

It therefore becomes evident that a great many children whose 
family ties cannot be severed, or children who are unattractive and 
come from poor, low grade homes, who are sick or impaired phys- 
ically or mentally, must be provided for in other than free homes. 

In many states which have developed strong free home agencies, 
agencies that do almost no boarding out, there has also grown up a 
number of institutions which under this system have to take over 
the job of caring for children whom no one is desirous of fitting into 
families. Moreover, many of the free home organizations have felt 
strongly that to dev,elop a boarding out service, that is to provide 
board in families for these children whom they could not place in free 
homes, would tend to decrease the scope of their free home work.' 

' The situation in Massachusetts has been pointed to as bearing this out. 
This state has approximately 10,000 children in families under the care of public 
and private organizations. Of the 10,000 approximately two-thirds are in board- 
ing homes. There is none of the free home development in the state such as holds 
in other states, but there is likewise none of the institutional development, because 
the public and private organizations are quick to give family care to a child even if 
board has to be paid when they are certain that such children cannot secure 
opportunity for free care. 

The situation in New York illustrates the resvdts of a non-boarding out devel- 
opment of the children's field. There has grown up alongside the importanj; free- 
home children's agencies an increasing institutional population. Part of this 
institution growth has no doubt been due to the subsidy system, but a large part 
has been due to the fact that there were no private agencies standing for the board- 
ing out idea. In other words, the case work method, involving elasticity and ad- 
justment to the needs of a particular situation, was not in evidence. 

The development of the children's Home Bureau of the New York City De- 
partment of Public Charities and the placing of many hundreds of children in 
families at board during the first year and a half of the Bureau's existence, is strik- 
ing proof of the wisdom of this addition to the free home equipment in the state 
and has suggested to some of the best institution people opportimities for growth 
and a transfer of activities from the institution to the family plan. 



126 The Annals of the American Academy 

It is utterly useless to say that family care is better than insti- 
tutional care for a particular child, unless we are prepared to give 
continuing, penetrating supervision. A children's society placing 
its wards in families and giving inadequate supervision is offering 
no arguments against institutional care but may be offering many 
in fayor of it. 

Good case work in the children's field, among other things 
involves seeing an accepted responsibility through to its conclusion, 
yet it is not good case work so to load a visitor with children placed 
out in families as to make it impossible for her to do more than pay 
a few fleeting visits in the course of a year. The standards set by a 
small number of children's organizations of forty to fifty children to 
a visitor are simply not accepted by children's agencies generally. 
If the development of opportunities for free home care is checked, 
the fault is due to the neglect of the workers rather than to the in- 
j urious results of the boarding out plan. Almost none of the agencies 
using either method exclusively have accumulated important history 
records for the children in their care. This has meant, of course, a 
lack of accurate and complete data which must preclude any scien- 
tific study. It cannot be stated too frequently that this whole ques- 
tion of child care is capable of scientific interpretation and unsup- 
ported opinions must give way to statements based on facts. 

On the other hand, few institutions have kept records of their 
work in such shape as to make it possible to study now the results 
of their services and determine wherein certain types can best be 
cared for in institutions rather than in famiUes. A careful study 
of case histories of children in need of temporary care, conducted by 
both institutions and family agencies, ought to disclose data as to 
which has brought the more helpful service to the children. 

The executive officers of the Massachusetts Trustees for Train- 
ing Schools, who have in charge the three state industrial schools 
for children, feel very strongly that whereas probation for a child in 
the community represents a procedure that should be tried in almost 
every instance where a .juvenile delinquent is involved, yet the 
dividing line between what a family can do and what a training or 
industrial school can do for a child is not clearly and definitely under- 
stood by very many children's workers. This same indefiniteness 
holds in the matter of institutional and family care where neglected 
and dependent children are involved. The doctors and lawyers 



Foster Care of Children 127 

are constantly expressing naedical and legal problems in terms of 
cases. Dr. Richard C. Cabot's "Differential Diagnosis" is an 
evidence of something that we should have in social work. The 
problem of the best kind of foster care, whether in families or in 
institutions, could best be stated and understood if we had mono- 
graphs giving histories and treatments of given groups of children: 
children related; children without relatives or brothers or sisters; 
children with no special problems, others with very special problems 
of health, impaired minds, or bad habits. 

Returning to the matter of adoptions, it would throw great 
light upon a most important question if certain organizations dealing 
with neglected adoptive children could study and re-state for the 
public the histories and treatment of the children involved and give 
especially the reasons why these children had to be removed a 
second time often from homes of neglect. 

The case method is also admirable for use in weighing the ad- 
vantages and disadvantages of the community in which an effort 
is to be made to place children in families as against giving them 
institutional care. There are many communities in the United 
States offering less than a proper minimum in the way of social life. 
The schools are poor, the terms are short, industrial opportunities 
are nil, housing is bad, the country is sparsely settled, — it is foUj' 
for any children's worker to contend that where such conditions 
prevail proper family life with necessary neighborhood contacts 
will be found in sufficient quantity always to provide for all the 
children in need of care. 

The tendency of many of the child-placing agencies to sing the 
praises of the ideal home and then to dodge so far as actual work is 
concerned the care and adequate training of the more difficult chil- 
dren referred to them, with particularly serious results at the time of 
adolescence, has thrown upon the institutions a very difficult task. 
This has particular reference to the giving of care to dependent or 
neglected older boys and girls. Every well-informed child-placing 
agency knows that when children of twelve or thirteen or fourteen 
years are referred for care, the problem of treatment, and the cer- 
tainty of good results, are very different from the cases of much 
younger children. 

The family agency in receiving a child at this age has a much 
more difficult if not impossible task in building it into the texture 



128 The Annals of the American Academy 

of a family. Years of neglect make most necessary for the particular 
child very intensive, special care and not every good home, good 
from the standpoint of morals, cleanliness, intelUgence, etc., is able 
to provide that accumulation of interests which the adolescent child 
demands and has to have. The psychology of this particular chil- 
dren's situation has not been shaped up, at least so as to affect the 
work of children's organizations as a whole. 

A certain type of institution, the Uke of which is rare, might 
be so effective in giving care to these older children, or children who 
arrive at a period of dependency at a late age, as to be in advance of 
the family agencies; but there should be no uncertainty ^bout it 
and either of the plans can be entered upon with certainty only if the 
histories and treatment of each child involved are studied and the 
combined experiences properly interpreted. 

The extent to which institutional care is given by the Catholic 
Church to its children is a cause for constant comment, especially 
as this holds with reference to little children, because if there is 
flexibility in methods, these are the very children that are most 
easy to place in families. The difficulty of getting enough Catholic 
families into which these children might go has been offered by 
some as a reason for the institutional emphasis. The experience, 
however, of the New York Department of Charities in placing large 
numbers of Catholic children in homes of their own faith and in a 
district as congested as the area surrounding greater New York would 
seem in a measure to dispute this contention. It is also important 
to note the work of the Massachusetts State Board of Charity in 
placing its wards in homes of their own faith. 

In the giving of foster care, whether in institutions or families, 
there are other special considerations having a paj'ticular religious 
significance. With this constant emphasis on training along certain 
sectarian Unes as laid down by various religious denominations, 
there is interjected a special difficulty from the placing out stand- 
point. Good case work, irrespective of any interest in any particu- 
lar religious creed, will see to it that a child is placed generally in a 
home of its own rehgious belief; that is, a Catholic child in a Cath- 
oUc hoine, a Protestant child in a Protestant home, a Jewish child in a 
Jewish home. Now, it frequently happens that a home thought of 
for a particular child is good on every count except that it is of a 
different religious belief. Frequently the argument is heard that 



Foster Care of Children 129 

placement in this home for the child in question can have no serious 
effect on the child. It will be allowed to continue its own rehgious 
life, and the utmost respect will be paid to its own rehgious opinions. 
Holding Uberal religious views, the writer of this article feels that 
such an argument is wrong. 

Growing out of experience with a variety of children's problems, 
one does realize that the statement made above that few children 
are without ties of relationship which can be severed completely, 
is indisputably true. The child's early religious training results 
in the formation of certain interests and possessions which cannot be 
lightly dropped. Therefore, while a child will benefit physically and 
in many ways socially by care in a good home of other than its own 
faith, conflicts are presented to the child which affect it most seri- 
ously in its later reunion with family and friends. An element of 
doubt on a hitherto undebatable subject is injected at a time when 
the child is often least able to get his proper bearings. This would 
seem to lead to the plan that familiar religious atmospheres and 
training must be continued for a child when receiving foster care, 
involving as it may institutional care. There is the further argu- 
ment that unless a child is placed in his old religious atmosphere, 
he will wander from a particular rehgious denomination and may 
thus be lost to the membership of a particular church, a spirit of 
propaganda for which the writer has no sympathy. 

Careful follow-up records should be kept by every family or 
institutional organization of the foster homes in use; that is, after 
the initial reception investigation with all of its ramifications has 
been made and a decision to use the home has been reached, then all 
further contacts with that home should be summarized and entered 
on the record, so that the home's training and development under the 
direction of good family visitors, the results of care given to the 
different children received into the home, and the reasons for success 
or failure in given instances, should all be there. The records 
should also show changes in the family structure. In so many 
instances the children's agencies are prone to forget that the family 
organization as presented at the time when first used will not last 
forever, and that a very good home, good because certain members 
were there, may become a very bad home because certain members 
have died or left. An illustration of this is the home of a deserted 
wife whose husband had long been away, and whose children showed 

10 



130 The Annals of the American Academy 

the effects of her good trainmg. Her home was an excellent training 
place for children who had been deprived of their own parents, but 
became a very bad place especially for girls when the husband re- 
turned and the wife, out of a mistaken sense of responsibility, felt 
she could not turn him out of doors. 

Under such a record system, the visitors would be so accurately 
and completely informed as to choose the foster homes with 
greater certainty of success. If a number of children's organiza- 
tions were to keep such family records, it would then be possible to 
show under what family conditions the children, with all of their 
varying personalities, best develop. It would also be possible to 
show the homes that had been rejected or later disapproved because 
of the development of conditions which were not evident or were not 
discoverable at the time of their acceptance. Monographs on such 
records of experience would help all children's workers and every 
intelligent social worker dealing with children's problems would have 
a new value placed on her best work. 

The country is in the midst of its greatest social crisis. No 
children's organization need feel that more careful study will lead 
to its elimination for if it base all of its work on good case studies 
the treatment will be of the right sort. Case work with children 
means knowing them and when intelligent people know them they 
treat them wisely. Knowledge here is power to do the right thing. 



ESSENTIALS OF CASE TREATMENT WITH DELINQUENT 

CHILDREN 

By Henry W. Thurston, 
Member of Staff, The New York School of Philanthropy. 

So far as case treatment of delinquent children depends upon 
the authority of courts it is necessarily limited and colored by the- 
provision of the law establishing those courts; by the personality 
and judicial methods of the judges; and by the public opinion that 
created and sustains the laws; It is, therefore, a first requisite 
to continuous good case treatment of juvenile delinquents that there 
be a right attitude of the public mind, and that this attitude be ex- 
pressed in laws and court procedure which will permit and encourage 
good case treatment of the individual delinquent. A brief reference 
to the public opinion whioh found legal expression in the Roman 
law, the penal code of France and the English common law, com- 
pared with the American law which in many states gives a juvenile 
court chancery jurisdiction, will illustrate the necessity of a right 
attitude of the public mind towards young offenders as a basis for 
right case treatment. 

The Basis of Case Treatment in Public Opinion and Law 

The Roman criminal law treated the adult differently from the 
child by making a gradation from non-punishability-^seven years, 
through stages of "impuberes" (for boys till 14, for girls till 12) 
and "minority" to full maturity at 25 years, The amount of pun- 
ishment varied according to these gradations in age though not by a 
definite scale. There was no special judicial procedure or special 
punitive institutions for juvenile offenders. 

The penal code of France similarly distinguished between an 
adult and a child, placing the dividing line at 16 years. For 
offenders under 16, the law provided that if a child acted without 
" discernement " he was to be acquitted and either returned to his 
parents or sent to a house of correction for a definite time which 
must end when the offender reached the age of 20 years. If the 
offender under 16 acted with " discerpement " he was to be pun- 

131 



132 The Annals of the American Academy 

ished to a less degree than an adult according to a graduated scale. 
There was no minimum age for punishability and no special judicial 
procedure. 

The common law of England which has been followed by the 
statute laws of many American states gave seven years as the low- 
est limit of punishability. Above this age and below maturity 
during most of the nineteenth century, England and the United 
States have graded punishment according to the judicial opinion 
of the degree of responsibility of the young offender for his offense. 
Of this groping of the Roman, French and EngUsh public opinion 
toward discrimination in the treatment of juvenile offenders, as 
expressed in their laws, Philip Klein says: ' 

The law went half way toward treatment of the cause in acknowledging that 
lack of responsible, mature thinking is partly the cause of the offense, and in es- 
tablishing the presumption of only partial responsibility in the case of juveniles, 
but failed to go the rest of the way, however, to find that youthfulness being the 
cause of the lowered responsibility, it was this youthfulness or inmiaturity that 
had to be dealt with, rather than the remstining'ajnount of responsibility. . . . 

Though technically an offender against the law (the child) is really primarily 
a neglected child. Because of his irresponsibility and immaturity the child needs 
protection and training. When no protection and training are given the child it 
is likely to. act upon its own impulses, and these, often, in cases of destitution 
nearly always, take the form of an offense against the law.' 

The same attitude of pubUc opinion as formulated in law is 
authoritatively expressed by Judge Julian W. Mack. 

The underlying conception of our criminal law, despite all the reforming in- 
fluences that have come in, is still that of vindication, that the state must vindi- 
cate by punishing. This ought to be completely eliminated when we deal with 

children A child who has committed an offense, no matter what the 

natiu-e of the offense may be — even what we call murder — should be dealt with 
by the state, not as an adult is, merely to punish, but for the purpose of correction, 
for the purpose of training, for the purpose of education.^ 

That courts in states where public opinion toward juvenile 
delinquents has not yet become formulated in chancery law and in 
judicial practice for children's courts, are handicapped in their 
efforts to develop social case treatment of children, the testimony of . 
Presiding Justice Franklin Chase Hoyt bears convincing testimony. 

1 "The Treatment of the Delinquent Child in the United States," an unpub- 
lished paper which traces the trend above summarized. 

' Address before Judiciary Committee of the Constitutional Convention of 
New York State, June 29, 1915. 



Delinquent Children 133 

One of the handicaps which retards the Children's Court development at 
present is the impossibility of obtaining a comprehensive method of legal procedure 
under constitutional conditions. The court should have broader powers, and the 
present system of trials in children's cases should be done away with. 

It savors too much of the strict, narrow, criminal trial. If chancery or equity 
powers could be conferred on the court it would be possible to inquire into the facts 
and circumstances of each case at the first hearing to see whether the child is in 
need of the care and protection of the state without first having to make a technical 
finding of juvenile delinquency." 

Social case treatment of juvenile delinquents needs first of all, 
then, the baclcing, not only of public opinion but of public opinion 
formulated in law and carried out in practicfe. A second need, 
hardly less essential, is a similar public opinion formulated in law 
and judicial procedure which makes it possible that adults who are 
responsible for the neglect and delinquency of children can be 
reached either directly by the juvenile court, or by another court on 
the initiative of the juvenile court. In practice this means one of 
three things. 

(a) A juvenile court with jurisdiction over adults in theit domestic relations 
and in other cases of adults involving children. 

(b) A domestic relations court with jurisdiction in case of juvenile deUn- 
quents. 

(c) Two courts, one for juveniles and one for adults in close administrative 
cooperation. 

Case Treatment from the Time of the Offense until 
A Delinquent Is Placed on Probation 

There are two primary essentials in good case treatment during 
this stage. First, the delinquent should be so treated that the proc- 
ess itself tends to make him better. Por example, if personal cus- 
tody away from his home is necessary, that it shall be in separation 
from offenders and custodians who incite him to further wrong and 
in company with those who call out what is good in him. If home 
custody pending court hearii^g is even reasonably sure of producing 
the delinquent when wanted, and is not of itself a further encourage- 
ment to delinquency, it should be allowed. The second essential is 
that all the pertinent facts be found out, not only about the offense 
but about the offender and his habitual experiences and activities. 

The approved procedure from the time of the offense to the time 

• Annual Report of the Children's Court of the City of New York, 1916, p. 36. 



134 The Annals of the American Academy 

the delinquent is put upon probation (or dismissed or committed 
to an institution) is suggested by the following typical case: 

Three boys during their habitual street activities of a Saturday 
forenoon found out that the grocer was away for the day and that 
the transom was open. They agreed to go home to luncheon and 
to meet at 1.30 and go into the store. This they did, thus becoming 
in the eyes of the law burglars and thieves. They carried off sweet 
chocolate, Nabiscoes, cigarettes, gum, candy, cookies, etc., and hid 
their booty in a shanty back of one of their houses. The next day, 
Sunday, they went far into the open country and ate their plunder. 
Meanwhile a smaller boy who had seen the burglary told on them. 
On Monday the pohceman .filed a petition for each of the three 
boys with the clerk of the juvenile court. This petition stated on 
oath that (name, age, address of boy) to the best of the knowledge 
and belief of the petitioner is a delinquent boy in that (description 
of the offense). The clerk acting for the judge then issued a sum- 
mons upon the parents of these boys, stating that petitions had 
been filed charging them with delinquency and that a hearing had 
been set on a certain day and hour in the juvenile court, and direct- 
ing that they appear at that time with the boys. 

Pending this hearing a probation officer made an investigation 
of all the necessary personal, developmental, family, neighborhood, 
and school facts relating to the boys, so that the habitual activities, 
trend and opportunities of each boy became clear. The boys were 
also examined by a doctor and a mental specialist. 

Specialists in the study of delinquents agree that the short 
period between the detection of a child in deUnquency and the hear- 
ing before a judge who is to decide what is to be done with him is the 
best psychological time to secure the maximum degree of coopera- 
tion of the juvenile delinquent in efforts to understand the real 
reasons for his own misconduct and the essentials of the best plans 
to prevent recurrence of wrong- doing. 

In cases such as the above, with all these facts summarized in 
writing, — so that the judge can visualize not only the particular 
offense but the personality, habitual life, and future opportunities 
of the child, — the parents, the child, the probation officer, the com- 
plainant, friends and witnesses file up and stand before the judge. 
Here there are as many different variations in procedure as there are 
different judges and juvenile delinquents, but good case treatment 



Delinquent Children 135 

demands of the judge that when the hearing is ended he shall have 
produced certain very definite impressions on the delinquent and on 
his parents and friends: 

1. That they have had "a square deal" and a fair chance to tell the judge 
whatever seems to them important. 

2. That the judge has found out the real facts — that nobody has "put one 
over on him." 

3. That in his decision, even to commit to an institution, he acted not in 
anger or in an arbitrary way, but so far as his duty as a judge and the law permit, 
from a desire to help the offender "to do better" — "to give him a real chance." 

4. That if the delinquent is put on probation the judge has made clear that 
the probation officer is his representative who, like the judge, is not easily tooled 
amd will always give a square deal. 

Unless a majority of those who file out of the court room have in 
substance received the above four impressions, the judge has lost 
much of his psychological opportunity to make his contribution to . 
good case treatment of juvenile delinquents. 

In this process the juvenile court judge who is compelled to work 
under the criminal court law is sadly handicapped for the reasons 
that at the first hearing all that can be taken is testimony for and 
against the delinquency of the child; and that a remand of the case 
for a second hearing is necessary in order to secure the social investi- 
gation and physical and mental diagnosis upon which alone a sound 
plan of action can be based and stated in the decision by the judge. 
In short the judge is almost compelled either to decide upon a plan 
of treatment, on incomplete information, or to call the child and his 
parents back for a second hearing after hfe has had time to have the 
necessary facts collected. 

A decision upon insufficient information tends to the impression 
upon the child and his family either that they did not get a square 
deal or that the judge was fooled. A remand for an investigation 
often works real hardships upon poor people in causing loss of time 
and money and seems to them unfair. The remand also sometimes 
arouses contempt for a court that calls the child and his parents to 
its bar without knowing or getting at all the facts in the case. 
In other words, it is harder for a judge under a criminal court pro- 
cedure to send a majority of children and adults out of his court 
feeling both that they have had a square deal and that the judge can- 
not be easily fooled than it is for a judge under the chancery law. 



136 The Annals of the American Academy 

This is true even if the average decisions of the two judges are 
equally wise from a case treatment point of view. 

Returning now to the decisions of the judge re the three boys 
who were mentioned above as having burglarized a store on a Satur- 
day afternoon and who had been brought into court on petition and 
summons as before described, after all the necessary facts had been 
found out before the hearing, the judge was able to produce the four 
impressions above emphasized as important, although he made a 
different decision in each case. The investigation in the case of No. 
1 showed a normal nin^-year-old boy from a good home. He was 
mischievous and active but not vicious. He was in fourth grade in 
school and regular in attendance. His parents nbt only had a good 
home but now that they were alert tp the need of more careful plans 
and supervision for his spare time, were able to connect him with 
Boy Scouts and probably to secure a change of behavior without 
further aid from the court. The judge, therefore, dismissed him to 
the care of his parents. 

The facts in case No. 2 were that he was a twelve-year-old boy 
in the sixth grade. The father had deserted and the mother and 
boy were living with the boy's grandfather who ran a milk depot and 
route. The boy helped some in spare time but was much on the 
street. Once, after saving money for months, he had run away with 
other boys who planned to go south where they coiild see "tropical 
fruits and waving grain." The- judge, therefore, explained that he 
would allow the boy to continue at home on condition that he and 
his mother and grandfather and the probation officer would work 
together to prevent further wrong-doing. He was to be kept busy 
and happy, not only at his work, but also during his spare time activi- 
ties, which thus far had been unsupervised. 

The facts in case No. 3 were that the boy had previously been 
in trouble for truancy and also for joining with other boys in stealing 
inner tubes of automobile tires from a shed used as a garage. His 
mother was dead and his stepmother was afraid of being too hard 
on him. The father was brutally severe at times but away from 
home most of each week. The judge explained that he must see 
that this boy's habits and home were changed and that the boy's 
best chance to reform was in an institution unless a family home 
under more favorable conditions was possible. At this point an 
older brother who was married and whose home had been visited 



Delinquent Children 137 

by the probation officer offered his home, Iuh personal service and 
new school associations, together with membership in a Junior 
Y. M. C. A. which offered swimming and other recreations. Ac- 
cordingly No. 3 was put on probation to live at the home of his 
brother. 

In a group case like this some judges are careful to have only 
one deUnquent and his friends present at the time his decision is 
given, but even if all three boys and their friends are present, the 
emphasis of the judge, not alone upon the wrong-doing of each, but 
upon such conditions of home, play, school and work opportunity 
and supervision as will give each boy a real chance to conquer his de- 
linquent tendencies, gives all an impression of a square deal in the 
light of facts as they are. Good case treatment of several delin- 
quents who have been caught in the same offense does not often 
demand identical decisions by the judge, but usually a different 
decision in some particular for each. To the degree that the differ- 
ences in decisions are based on accurate knowledge of facts, under- 
stood by the delinquents themselves as well as by the judge, they 
and their friends will approve these variations in decision. Such 
variations in the judge's decisions, however, are not likely to be ap- 
proved by the dehnquents and their friends if the major emphasis, 
as is too often true in criminal courts, is laid on the offense rather 
than on the task before each offender of so living in future that no 
other offense will be committed. 

Case Treatment by the Probation Officer 

The case treatment now passes into the hands of the probation 
officer. The equivalent of the first interview (in family cases need- 
ing a social worker), of investigation, of analysis of facts, of diag- 
nosis, and of the formation of the outlines of a plan has already 
been taken. 

It is now the task of the probation officer to work out with the 
delinquent and his parents or guardians the details of a course of life 
and conduct that will lead to prevention of further delinquency and 
to right habits and ideals of life. Right here is where too many 
probation officers fail to do good work. The delinquent knows he 
has done wrong. He usually has at least a brief desire and intention 
to do right. What he needs and his parents need is a clear but elas- 
tic program for the week which will give the deUnquent such good 



138 The Annals of the American Academy 

times as boys and girls ought to have, without constant temptations 
to evil and further delinquency. In other words he needs a pos- 
sible program of things to do which seem to the delinquent worth 
doing in all his spare time. To this end a careful study of the re- 
sources of home, school, playground, club, park, library, etc., needs- 
to be made by the probation officer, the delinquent and his parents, 
until it is clear how a week can be spent without doing wrong and 
yet in such ways that the delinquent can enjoy most of it. Unless 
such a program can be fairly definitely, but with great elasticity, 
laid out and approved by the delinquents, the chances for over- 
coming serious delinquencies are poorer than they ought to be. 

It is essential to the success of probationary care of delinquents 
that they be helped to see and to choose possible right courses of 
action at the precise points where before they have once, or fre- 
quently, chosen wrong courses of action. It is plainly futile to ex- 
pect reform under probation unless the child himself can be led to 
see and feel that right action is not only possible but worth while 
from his own point of view. Not alone what the probation officer 
thinks is right and desirable for the child, but what the delinquent 
himself can be led to see is right, desirable and possible, will be 
really effective in changing his behavior. To this end the relation 
of probation ofiicers to probationers must become one of reciprocal 
confidence and sympathy. Underneath this, but rarely used, is of 
course the authority of the court. The probation officer should 
also have such an intimate knowledge of the habitual life of the de- 
linquent at school, at home, in playground, street, and spare time, 
that the delinquent will feel the probation officer, while his friend, 
cannot be fooled. 

Whether the probation officer should be the same person who 
made the investigation of the delinquent's home and habits for the 
hearing is a secondary question. The success of a good probation 
officer depends upon his skill in influencing the probationer and 
changing wrong behavior into right behavior, not on the mere fact 
that4ie came into the life of the delinquent before or after the hearing 
before the judge. 

A similar question is that of reporting to the probation officer by 
the probationer. In some way the delinquent must be led to act 
honestly and on his own responsibility toward his own reform. In 
many cases to report to the probation officer at a certain time and 



Delinquent Children 139 

place tends to develop his honesty and sense of responsibility. The 
probation officer must, however, have many other sources of inform- 
ation and means of guidance of the probationer. If he relies on the 
report alone, he will often be fooled and his influence be reduced to 
less than nil. Good case treatment means an adoption of available 
means to the end that habit and voluntary behavior become right 
with each child. No general rules are applicable to all cases of sick 
morals any more than to sick bodies. Until a probation officer 
learns this he is not so successful as he ought to be. 

The application of this principle of individualization of treat- 
ment explains what the right time and method of ending the proba- 
tion period are. If opportunities for right choices of behavior for 
24 hours a day for seven days in the week are found impossible for a 
delinquent in his home and neighborhood; or if, although good 
choices are possible, his actual choices are habitually wrong, the 
probationary period ought to end by commitment so that control 
may be enforced, or by some change of environment or supervision 
that promises ji^rogress toward reform. On the other hand, when not 
only real opportunities for right choices of behavior have been seen 
by the delinquent but he has learned to choose them for himself, the 
probation officer should give the delinquent -the encouragement of 
knowing that the authority of the court has been ended. Like- 
wise this termination of probation should be entered on his record at 
the court. HeiShould know that henceforth he is thought strong 
enouglTto do righf with merely the personal encouragement of the 
probation officer. Whether or not this close of the period of proba- 
tion shall be celebrated by having the delinquent released in person 
by the judge cannot be stated without knowledge of the case. 
Plainly some girls who have left sex offenses far in their past, should 
not be compelled to go again to court. Good case treatment of de- 
linquents demands, at the close, as at the beginning and all through, 
that the process of release from probation should be not a matter of 
cold routine, but an act of "constructive friendship." 

The final step is that the probation officer should be a voice 
in his commuity urging, in season and out of season, the suppression 
of causes and conditions which make for delinquency and also urging 
with still greater earnestness the provision of adequate facilities and 
agencies that make for wholesome juvenile life and education. 



THE HOMELESS 

By Stuart A. Rice, 
Formerly Superintendent, New York Municipal Lodging House.' 

Intelligent treatment of homeless men and women requires a 
vivid understanding of the reasons for their homelessness. Under 
present methods of industrial management this condition is de- 
manded of a vast number of workers. By becoming or remaining 
homeless, they render specialized services of great importance to 
society. Nevertheless, the living and working conditions imder 
which the services are performed react disastrously upon their 
character, even to making them subjects of social case treatment! 

The truth of these statements is to be illustrated in the employ- 
ment office districts of any large city. A recent inspection of the 
labor agencies from Fourteenth Street to Chatham Square, along 
the Bowery in New York, disclosed, in all, opportunities forfourteen 
men with families! And these were required to be "foreigners!" 
The thousands of other jobs offered (tacitly understood, not openly 
stated) were for "homeless men only." 

The Homeless in Relation to Society and Industry 

The writer has been a member of one of thoSfe unkempt com- 
panies you have seen slouching along the %tregj; from the labor 
agency to the railroad depot. He has made his abode in the bunk 
houses provided for these men. His experiences have led him to a 
real appreciation of the abnormal living conditions that are forced 
upon great masses of casual and seasonal workers throughout 
America. Many of the evils inevitably resulting from these un- 
natural conditions may be removed in individual cases by careful 
diagnosis and persistent social treatment. But tjie background of 
industrial organization (or disorganization) will in nowise be altered 
by the most careful case work. Either the men and women re- 
corded in our own case files, or thousands of others like them, will 
still be compelled to live abnormal lives in order that they may live 
at all. 

' At the time of writing this article Mr. Bice was still holding this position. 
— ^Editor. 

140 



The Homeless 141 

Homeless men are demanded to build the bridges and tunnels, 
the irrigation systems and railroads, to harvest our forests and em- 
bank our rivers. They are the pioneers of modern industry. They 
go hither and thither to the rough, unfinished, uncomfortable places 
of the world, to provide homes and civilized comforts for those of 
us who follow. Meanwhile they hve in bunk houses. Homeless 
women are preferred to do the "dirty work" in our public institu- 
tions and to scrub and clean at night in our hotels. Generally only 
they are willing to accept the work and the hours demanded, 

Homeless men, for the most part, make up our "labor reserve." 
This reserve is highly essential. If some workers were not unem- 
ploj^ed in slack or normal conditions of industry, additional hands 
could not be employed in periods of increased activity. The home- 
less are usually the less efficient. Furthermore, they are without 
dependents. Socially and economically, therefore, as things now 
are, it is advantageous for society that they shall be the first em- 
ployes discharged when reductions in force are essential and likewise 
the last to be reemployed. 

Homelessness and intermittent employment, therefore, go 
together. They are the major characteristics demanded by society 
of a large number of its workers. But certain other characteris- 
tics are encouraged. In the absence of organized social control 
over industry a restless instability of temperament is desirable to 
afford fluidity to the labor supply. Employes' indifference to 
cleanliness is fortunate for numerous employers who find it im- 
practicable to supply bunk houses with running water. Even the 
periodical debauch in the city after pay day has psychological re- 
sults which prove convenient to the employer. Men or women 
without money are docile. How otherwise could they be induced 
to return to jobs affording no chance of normal living? These 
unfortunate developments of habit and character we attempt to 
combat in individuals by social case treatment. Yet, they are in a 
sense vital elements in our patients' professional training! 

Classification of the Homeless 

It is convenient to use the following grouping employed by Mrs. 
Alice Willard Solenberger:^ (1) the self-supporting; (2) the tempo- 
rarily dependent; (3) the chronically dependent; (4) the parasitic. 

2 A. W. Solenberger, "One Thousand Homeless Men," p. 10. 



142 The Annals of the American Academy 

We may say with approximate correctness that in the order 
named, these classes mark the degrees of progressive deterioration 
through which every homeless individual tends to pass. That 
more men and women of the first two groups do not actually pass 
into the third and fourth is a sure evidence of fundamental human 
character. Everything in the lives of homeless men and women 
drives them in the direction of chronic dependency and parasitism. 
Many fight on against odds, day after day,~to retain, their precarious 
foothold upon the social ladder; others go down in the struggle, their 
spirits unbroken to the end. Still others, "exhausted by three or 
four generations of overwork, on the slightest menace of lowering 
prices the first to be discharged," ' prove easy victims to the disin- 
tegrating tendencies of their environment. 

The Genebal Aims of Case Tbeatment 

The first requirement in social treatment of the homeless adult 
is to check his progressive deterioration toward chronic dependency 
or parasitism. Existing faciUties for constructive treatment are 
very meagre. Our efforts are everywhere counteracted by the 
encouragement which "society gives to the very tendencies in our 
patient that we desire to eliminate. If we are dealing with large 
numbers of the homeless we cannot expect a restoration to normal 
living in more than a small proportion of cases. The best work we 
can do at present, therefore, is to assist the bulk of our patients to 
"hold their own." 

Another general objective is in reality a matter of diagnosis 
rather than of treatment. In any group of homeless individuals 
there may be singled out proper cases for specialized treatment in 
which homelessness is a factor of minor significance. The sick, in- 
sane, feeble-minded, blind, handicapped, inebriate and immigrant 
are regarded as such typical cases in the volume of which this article 
forms a part. All of these are found among the homeless appli- 
cants for shelter or relief at any municipal lodging house or charity 
application bureau. Many lost and broken fragments of famiUes 
may be recovered from among the homeless. Married men or 
women, and boys who have run away from homes, will always be 
discovered if applicants are carefully interviewed. As soon as the 

'Edmund Kelly, "The Elimination of the Tramp," p. 4. 



The Homeless 143 

-facts in these cases are ascertained, the problems become those of 
family case treatment and should be referred to a family agency. 

With the development of facilities for diagnosis and with the 
building of additional agencies for specialized treatment, the social 
function of an agency or institution for the homeless will become 
primarily that of a clearing house. In every way afforded them 
social case workers should further the breaking up of our homeless 
group into its component parts. 

Treatment of the Self-Supporting 

The most numerous group of homeless, employed persons with 
whom I am acquainted is that which is known at the New York 
Municipal Lodging House as "the Saturday night clean-ups." 
The registration of applicants is proverbially largest on Saturday 
nights. The men responsible for the increase are generally employed 
through the week, usually at odd jobs that must be "caught" each 
morning. Consequently, by seeking a free bed and meals at the 
Municipal Lodging House on Saturday night, the earnings of that 
day may be reserved for Sunday's living expenses. Some wish to 
"see the doctor"; others want to "get a bath and fumigation," in- 
order to rid themselves of vermin acquired in cheap commercial 
lodging houses; still others desire to have their clothing washed in 
the laundry of the institution. Women frequently are led to our 
doors from the same motives. 

The problem here represented is primarily one of labor and 
housing rather than of social case work. , There is no formula of 
social case treatment for the needs of these men and women. Most 
of them are independent in attitude and fairly self-satisfied regard^ 
ing their economic and social status. They will not accept services 
from the institution other than those they request. If molested by 
"social service busy-bodies" they will not return, and whatever 
opportunity existed for their physical and moral sanitation will have 
been lost. However, if their "clean up" is supplemented by a 
friendly but,iny)ersonal welcome the institution may at,least con- 
tinue to be a very important agent in community sanitation. 

A group of self-supporting men and women more susceptible 
to case treatment than those described above, is illustrated by the 
low paid hospital helper employes of the public charitable institu- 
tions of New York City. Customarily they are recruited from the 



144 The Annals of the American Academy 

patients and inmates of the institutions themselves. They work for 
a much lower rate of compensation than is paid for equivalent serv- 
ices elsewhere, and they are recognized officially by the City of 
New York as a distinct type of semi-dependent employe. 

In his dual capacity of employer and landlord, the head of an 
institution is in a position to render social service to these employes 
of a kind impossible when they are patients, inmates, or applicants 
for relief. The Municipal Lodging House recognized this fact in 
the formulation of a definite policy regarding the filling of positions 
within the institution; so far as efficiency in administration permits, 
the Social Service Bureau is the employing agency for these house 
positions. Lodgers who show possibilities of reclamation become 
our employes. As soon as possible they are promoted, and even- 
tually are placed in permanent outside employment, carefully 
selected for its influence upon their habits. In this manner, similar 
opportunities are continually made for other lodgers. 

It is most essential for the success of this program of social serv- 
ice to employes that group loyalty, and group interests be developed. 
Frequent meetings of employes should be held at which common 
'problems of organization and management may be discussed in a 
democratic way. Outdoor athletic sports are invaluable as a means 
of promoting loyalty. Holidays may be the occasion of gatherings 
at which songs, instrumental music, recitations and special features 
will supplant the institutional atmosphere with that of a community 
festival. 

If regular recreational and educational opportunities are not to 
be had at the institution they will be sought in the comer saloons. 
Various clubs are practicable. A large reading and smoking room 
provided with books, papers, magazines, writing materials and 
games is a popular success at our Municipal Lodging House. I was 
once complimented by an unpaid employe for the choice selection of 
Greek and Latin poets upon our shelves. He chanced to be a former 
Yale man. The books (received in a donation of cast-off materials) 
had given him many hours of intellectual pleasure! • - 

Supervision of employes' expenditures is helpful in many in- 
stances. Some have never learned the value of money and spend it 
foolishly. Others are unable to withstand the temptations of drink. 
Employes at the Municipal Lodging House are encouraged to deposit 
their earnings with me for the purchase of necessities, for transfer to 



The Homeless 145 

a bank, or for investment in War Savings Stamps. A positive gain 
in self-respect is evident in the individual who has purchased cloth- 
ing or accumulated savings. In some cases I have found it desir- 
able to keep employes continuously in debt to me by advancing 
them money for legitimate objects. The amount due is later de- 
ducted from their salaries. The invitation to membership in the 
Red Cross was recently accepted by five-sixths of the hospital 
helper employes of the Municipal Lodging House, but a small pro- 
portion of whom were receiving in excess of twenty dollars per 
month. 

The development of a system of credit or of token money, such 
as has been found effective at Sing Sing, would be of the utmost 
value in the rehabilitation of these men and women. The object 
of such a system would be to pay employes in the things they re- 
quire — ^tobacco, clothing, shoes, moving picture tickets, etc. The 
present cash salary payment is in reality an inducement to spend 
the month's wages in one grand debauch. Saloon keepers in the 
neighborhood of public institutions habitually ascertain when em- 
ployes are to be paid and are shortly after in possession of a large 
part of their earnings. 

Appeals for assistance are often received from men or women 
who have paid employment but who are temporarily without funds. 
It should be the policy of a social agency to extend whatever credit 
is needed by these individuals for necessities. This should be a 
business transaction throughout and the suggestion of charity ehmi- 
nated. The individual to whom credit is advanced may be placed 
upon his honor to repay the loan when he is paid. Upon their verbal 
promise to repay the institution, a number of men. holding positions 
receive maintenance at the New York Municipal Lodging House 
every month. The independent and self-respecting manner in 
which some of these men walk up to the counter to pay their bills 
speaks for the effectiveness of the method. 

The Tempobarily Dependent 

The demoralizing effect of involuntary unemployment on in- 
dividual character is not due to the absence of employment itself, 
but rather to the inevitable consequences of its absence. It is due 
to the enforced lowering of Uving standards and to the worry and 
uncertainty of seeking another job. Even the most callous man or 



146 The Annals of the American Academy 

I 

woman is sensitive to continued rebuiifs in a fruitless search for 
work. I know of nothing that will so quickly shatter the self- 
respect that is essential to a freeborn individual. 

A period of unemployment from which these consequences are 
removed, in other words a vacation, — ^is considered to be of greatest 
value for the worker's reinvigoration. It follows that if unem- 
ployment could be relieved of its present psychical and material 
results, it might become a boon rather than a curse to the worker. 

The responsibility for finding a new job, therefore, must be 
lifted from the individual who is out of work, and placed upon an 
employment exchange. It logically follows that the responsibility 
for his efficient physical maintenance while unemployed must also 
be removed from the individual. He may then utilize his period of 
unemplojrment as a time of physical and mental reinvigoration. 
Good food, recreational facilities and positive educational oppor- 
tunities in a broad sense may result in a refreshed, better equipped 
individual when the next job is found, rather than in a weakened, 
discouraged- and less efficient worker. 

There is an apparent danger that in this shifting of respon- 
sibility the unemployed individual may become pauperized. No 
system which maintains a worker in physical and mental efficiency 
during idleness can have this result to the same degree as one which 
allows him to deteriorate and lose physical and mental efficiency. 
Nevertheless, he should be made to feel his own responsibility toward 
the agency that has assumed the risks of his unemployment. A 
work requirement clearly sufficient to paj' the costs of the advan- 
tages received is one means of avoiding any pauperizing tendency. 
If this is impracticable, the individual should be obligated to repay 
this expense when he is once more employed. 

Many periodical drinkers may be classed as temporarily de- 
pendent during lapses from sobriety for the reason that during the 
greater part of the time they are self-supporting. Their contact 
with social agencies usually occurs immediately following a periodi- 
cal spree while they are still recovering from its effects. The 
victim is invariably repentant. Advice, moral suasion and " preach- 
ing" at this time are usually quite useless, as the convalescent will 
go farther in his self-denunciation than the social worker in his 
"preaching." The first necessity is to restore him to a condition 
of physical effciency. Good food, sleep, rest and fresh air are 



The Homeless 147 

essential. When he is once more ready to take work his choice of 
a position becomes of utmost importance. Factors of his old en- 
vironment may have been responsible for his downfall. If em- 
ployment can be obtained where these factors do not exist, the next 
spree may be averted. Even if sprees continue, but the intervals 
between them are lessened, there is a net gain for society and the 
individual. 

It may even be necessary to accept our patient's periodical 
necessity for drink as a fact, and attempt to arrange his employ- 
ment so that it may be obtained without interference with his work. 
The following example is in point. A male stenographer with whom 
the writer is well acquainted lived for some time in a charitable in- 
stitution where he was employed. Because the head of the insti- 
tution was both employer and landlord, sobriety and good behav- 
iour on seven days per week were required of employes. Each 
few weeks brought the stenographer's inevitable fall from grace. 
Finally, when all interested in his case despaired, he obtained a posi- 
tion with a commercial house where employers cared nothing for 
his habits outside of working hours. For two years he has con- 
tinued to give good satisfaction to this firm, has not missed a day 
and has received promotions. The interval between Saturday noon 
and Monday morning has been sufficient to enable him to follow 
a drinking schedule that has not interfered with his work. 

The writer views pragmatically the question of religious in- 
fluences in the case of drinking men and women. Without doubt 
there have been many complete and successful "conversions." On 
the other hand, I have known a number of men who were most de- 
vout testimony-givers at mission services who were elsewhere loud in 
their blasphemy and religious ridicule. Likewise, I have known 
deeply religious men to be hopeless inebriates. Where early envi- 
ronment affords a basis of appeal, religious instincts may prove an 
effective starting point for rehabilitation. 

Applications are continually received at the Municipal Lodging 
House of New York from hospital convalescents, pre-confinement 
cases and dispensary patients. The first have often been dis- 
charged prematurely from over-crowded hospitals. The second 
and third ought many times to be admitted to a hospital but are 
excluded for the same reason. In the meantime the problem is 
forced upon agencies for the homeless. 



148 The Annals of the Amebican Academy 

These cases emphasize the necessity for a competent medical 
examiner on the staff of the agency for homeless. Our Municipal 
Lodging House physician must continually assume the r61e of an 
advocate. He must prove clinically, and sometimes dialectically, 
that certain homeless inmates are sufficiently ill to make their 
admission to the hospital imperative. This situation is vaguely 
understood by many of our homeless applicants, who come to us 
requesting to be sent to hospitals. Convalescent, dispensary and 
maternity cases should be provided with light. work suited to their 
physical conditions. Great care is essential, however, lest overwork 
result. 

The Chronically Dependent 

Very few persons who have once become chronically dependent 
ever regain a place among the self-supporting. The result is pos- 
sible by intensive personal work with a minor number of cases. 
The study at present being given to the problem of reabsorbing war- 
cripples into industry will doubtless shed much light on the possi- 
bilities of rehabilitation of certain types of chronic dependents. 
"Shell shock" and battle wounds undoubtedly have their counter- 
parts in occupational disease and industrial accidents. The devel- 
opment of plans for training war- wrecked men and finding employ- 
ment openings suited to their individual handicaps, will be of quite 
the same advantage to men who have been similarly wrecked in the 
struggles of peace. 

The aged and infirm are conspicuous among the chronically 
dependent. It is customary to consign them promiscuously to the 
almshouse. Yet many of them to avoid this "disgrace" are 
attempting under terrible handicaps to remain self-supporting. 
Employment may be found for some in positions where age is no 
great detriment. The first placement made by the Employment 
Bureau of the New York Municipal Lodging House was of an elderly 
woman who was to have been sent to the almshouse. She is still 
in this position. There are many such cases. 

In spite of these possibilities of delaying the inevitable approach 
of death or complete dependency, the majority of the aged and 
infirm men and women who appear at institutions for the homeless 
must be sent to the homes for aged and infirm. A great deal of tact, 
good judgment and sympathy is often necessary to persuade these 
pitiful individuals that this is their only possibility. 



The Homeless 149 

Men and women with physical handicaps are infrequently- 
doing the work for which they are actually best fitted. A man 
who lacks an arm or fingers may be trying to make a living by truck- 
ing in a freight house. Men with weak eyes register for positions 
as clerks. The struggle for existence is severe and discouraging 
for those who are thus handicapped, and who have no one to guide 
them into employment for which they are better suited. Great 
care is required to prevent them from following the easy road into 
mendicancy, — a road continually opened by the unthinking but 
well-intentioned almsgiving of the public. 

A desirable readjustment of employment may sometimes be 
made in a placement agency. The weak-eyed clerical worker may 
be led to discover that he is adapted to employment where the 
intensive use of sight is not essential. The one-armed longshore- 
man may be given work as a watchman where the loss of an arm is 
not an important disqualification. If the handicap be serious and 
the individual discouraged or unenterprising, however, the assistance 
of special agencies may be necessary. The New York Lighthouse 
for the Blind, The Association for the Aid of Crippled Children and 
The Old Men's Toy Shop maintained by the Association for Im- 
proving the Condition of the Poor have demonstrated something 
of what may be accomplished in readjusting the lives of the handi- 
capped. 

Mental deficiencies are responsible for much chronic depend- 
ency. Many instances might be cited of morons and even medium 
grade imbeciles, aimlessly drifting from one social agency to another 
over extended periods of time, without any attention being paid to 
their mental conditions. 

During the early spring of 1914 the writer lived for a number 
of days in the New York Municipal Lodging House disguised as a 
homeless applicant. While he was employed one morning upon 
one of the institutional "work details" to which he was assigned, 
his attention was attracted by a boy whose physical degeneracy and 
mental feebleness seemed apparent at the most casual glance. The 
boy stated that he was twenty-one years of age and had just been 
put out of his father's home in Long Island City. His responses 
showed the mental development of a child. Two years later, after 
the writer had become Superintendent of the Municipal Lodging 
House, the self-same boy was observed one night at our registration 



150 The Annals of the American Academy 

window. Inquiry developed the amazing fact that for these tw( 
years he had been drifting about the streets of New York, working 
at occasional odd jobs, a frequent applicant at social agencies 
Yet never in that time had any one taken the trouble to have his 
mentality tested. The mental clinic to which he was subsequentlj 
sent classed him as an imbecile with a mental age of six years! 

Whenever mental deficiencies in a patient are clearly estab- 
lished, institutional care under strict supervision is the only satis- 
factory solution. But the insufficient capacity of appropriate in- 
stitutions renders the solution unavailable in multitudes of cases 
When the commitment to institutions of morons and harmless 
psychopaths has been impossible, we have found it of value to send 
them to employment in menial capacities in pubUc hospitals with 
the full cooperation of the hospital authorities. Although employes, 
they are then under an informal supervision by superiors of profes- 
sional experience. 

Where habits of drink appear to be the predominant factoi 
among the causes of chronic dependency, we must again turn tc 
institutional treatment as offering the only probabihty of cure, 
But available facilities for homeless inebriates are even less ade- 
quate than facilities for the feeble-minded. The City of New York 
provides a farm colony for inebriates and drug addicts at Warwick. 
This is the only public establishment in New York where farm colony 
treatment for inebriety may be obtained. Yet it has a permanent 
capacity for one hundred men only. The Municipal Lodging House 
could furnish this number of men who need its method of treatment 
on almost any day of the week! 

Mental deficiency, illiteracy and alcoholism are sometimes 
combined together, in varying degree, in a single homeless indi- 
vidual. No one of the three factors may be sufficiently pronounced 
to make possible specialized , treatment for that handicap alone. 
Yet in combination they produce an individual of general incom- 
petence who seems quite hopeless as a subject for constructive 
effort. Many of these general incompetents are the products of 
child-caring "homes." Condemned to institutional existence at 
the beginning of their lives, as adults they appear to have no po- 
tentialities for anything better. Some were constitutionally in- 
ferior at the start. They have insufficient ambition or persistence 
to follow of their own volition any program which they, or someone 



The Homeless 151 

for them, may outline. Forcible commitment to a farm colony and 
vocational school constructed after the Swiss type would offer the 
best means of benefiting the individual and making him self-sup- 
porting. There is idle agricultural land in abundance for such 
colonies, while the importance of increasing our agricultural out- 
put gives a powerful additional argument for their establishment. 

Proposals for the creation of such colonies were made in New 
York last sprmg. The proposals oontemplated the use of the 
Municipal Lodging House as a clearmg center from which individ- 
uals m need of farm colony treatment would be presented to the 
magistrates' courts and by them committed on indeterminate 
sentences to the farm colon>'. 

The Parasitic 

Many men and women, normally self-supporting and inde- 
pendent, will become temporarily parasitic under certain circum- 
stances. The migratory worker en route to the harvest fields is an 
illustration. Valuable and respected employes of the Municipal 
Lodging House when drinking have been seen begging promiscu- 
ously upon the streets. 

A large minority of homeless men, therefore, are occasional 
beggars, as well as occasional applicants for charitable assistance. 
But the professional mendicant is seldom seen at charitable agencies. 
He is invariably "wise," and can "work the public" much better. 
Furthermore, his income is usually sufficient for his support. 

The need or desire for obtaining money without work is un- 
doubtedly the initial occasion for mendicancy. But this desire soon 
becomes only one of the impulses which keep beggai's at the trade. 
Mendicancy has its roots in gambling instincts and it satisfies a 
certain cravmg for adventure. The constant possibility of a large 
gratuity, the never ending speculation as to the next benefactor, 
the fascinating game of "hide and seek" with the police, all give to 
the mendicant's Ufe a daily feverish adventure, the counterpart of 
which is found only in gambUng, prospecting, and other hazardous 
occupations. 

Suice a thrist for adventure m the mendicant's soul is satisfied 
by his maimer of living, no mere assurance of a Hvelihood equal to 
or exceeding that which he obtains from begging will suffice to 



152 The Annals of the American Academy 

wean him away from it. Only a legitimate occupation offering 
the equivalent in chance and adventure will serve the purpose. 
Many street trades do offer an approach to this equivalent. A 
news-stand where th^ crowds are surging past may prove the means 
of restoring the mendicant to productive life. In the cases where 
age or extreme physical handicaps render self-supporting employ- 
ment impossible, the mendicant must be committed to an alms- 
house. Severe measures, if necessary, are justified to break up the 
wasteful and fraudulent practice of street begging. 

The " I won't work," at least among the lower strata of society, 
is largely a popular superstition. I have seen very few men, not 
classed as mendicants, vagrant psychopaths or mental defectives, 
who would not work under conditions which they considered to be 
just. Not long ago it was generally believed that some men and 
women preferred unemployment, homelessness and himger to 
honest labor. This opinion seems to have been definitely aban- 
doned by thinking people. In January, 1915, 2,500 homeless de- 
pendents were sheltered in the Municipal Lodging House of New 
York each night. This population was reduced within eighteen 
months to little more than 100 per night. The same relative re- 
duction occurred in similar institutions throughout the country. 
It is very evident that the great majority of the alleged "I won't 
works" of three years ago secured work and are still employed. 
Yet this rule, Uke all others, is occasionally proved by its exceptions. 
It is sometimes found necessary to refuse the privileges of the 
Municipal Lodging House to men and women who will not avail 
themselves of honest opportxmities for employment. 

The charity rounder, the last of. the parasitic types wliich I 
have particularized, is usually a rounder because he has never 
learned to do anything effectively. He follows the easiest way. 
When placed at some simple task within his experience and intelli- 
gence, he may serve faithfully and well over considerable periods of 
time. Definite training for simple tasks, followed up by careful 
supervision when employment is obtained, may definitely remove 
him from the parasitic class. 

The methods of case treatment described above are crude and 
undeveloped. We have hardly gone further than attempts to 
define our problem. Among the human gains that may come from 
the world war, will be new and better methods for the treatment 



The Homeless 15c 

■of the homeless. For stiU greater gains may we hope: that out o 
the slaughter may come a new estimate of the value of human Ufe 
"that homelessness as a condition demanded of workers in returi 
for existence may be banished; that the right to normal living maj 
become imbedded in the social conscience of our people. 



ACLOHOL AND SOCIAL CASE WORK 
By Mary P. Wheeler, 

Secretary, Clinton District, New York Charity Organization Society 

Like all other problems in social case work, the problem of the 
excessive use of alcohol is seldom if ever found alone. It is almost 
invariably bound up with other complications. Granted that 
either the father or the mother of a family uses alcohol, there is 
inevitably connected with that fact a chain of events which often 
brings social, physical and mental problems with them. We are 
frequently so engrossed with the fact that our clients use alcohol to 
excess that we forget to see the other problems involved; or we may 
see the other problems first and come to the fact of alcoholism after 
much time has beeri spent planning for the family's welfare along 
other lines. In our investigation in all cases we should be building 
up a group of facts both physical and social which when put 
together should forewarn of a possible hidden drink problem. 

The combinations of problems in which drink is a factor which 
seem to occur most often are drink and immorahty, drink and a 
mental defect or mental weakness, and drink and a physical defect. 
The following example illustrates the first combination: 

Through failure to provide for his wife and child, Mr. D. who was obviously 
a drinking man, had lost a good home. The family was found living in a miserably 
furnished room. The investigation confirmed the story of degradation through 
drink. There was a painstaking period of treatment which included both institu- 
tional and home care and also the religious influence of his church. It was learned 
finally, instead of at the outset, that Mrs. D. was also a drinker, a secret one, and 
immoral. As Mr. D. had no confidence in his wife, there could of course be no real 
incentive for a home. The mixed problem should have been recognized at the 
beginning. 

In the following instance we have an illustration of drink and a 
mental defect. 

Mrs. W. talked freely of her condition and admitted she could not take alcohol 
without its immediately affecting her. We knew her husband earned good wages, 
yet we found them living in a basement, having scarcely any furniture. It devel- 
oped that a sister continually tempted Mrs. ^^'. to drink and the husband himself 
deliberately brought alcohol into the house. But most important, we found that 
Mrs. W, was worried because she " heard voices." We then took her to a mental 

154 



Alcohol and Social Case Work 165 

clinic where she was given medical attention and careful advice. Her interest 
was aroused in freeing herself. She insisted on staying at home, attending to her 
house and children. In a frank talk with her husband we made him face the fact 
that he had been doing a large share in dragging his family down. With everyone 
working together with equal knowledge of the facts and the goal to be reached, this 
family won out. Surely, however, this wasnot a simple case of a drink problem. 

In the third case, Mr. X. said he drank because he felt sick all 
the time. We found the real trouble was tuberculosis, following 
years of drinking and unsteady habits. The plan of treatment was 
not made primarily for the man who drank. It was for the man 
with a communicable disease. It is indeed imperative that treat- 
ment begin with a correct diagnosis. 

If it is true that the problem of alcohol is seldom if ever unat- 
tended by other complications, it follows that one can never gen- 
erahze regarding the users of alcohol. The principle of individuali- 
zation of treatment applies in this field as in every other field of 
social case work. Our plan of treatment is further comphcated by 
the fact that the user of alcohol is often a member of a family group 
which must also be taken into account. Too much stress therefore 
cannot be laid on the importance of studying the client, of getting to 
know his background socially and physically. Although much may 
be learned from our client himself, it is often preferable to gain much 
information before any decisive interview with him takes place, in 
order that the worker may be more free at that time to begin treat- 
ment. Such information should include knowledge of whether this 
is his first breakdown or whether he has made and forgotten good 
promises before. The age of our client is another important factor. 
If he is young, he has no doubt taken to drinking for social reasons, 
or to try to prove how manly he is. If he is middle-aged, it may be 
the result of a social habit formed in his youth. If he is older, he 
may be trjdng to forget that he is past his best working period or he/ 
may be trying to keep himself stimulated to compete with younger 
men. If our client is a woman; this should be gone into even more 
carefully and special attention should be paid to her nervous organi- 
zation. / 

. While in most case work it is coTiBidered best to interview our 
client in his or her own home, in case work with the man or woman 
who drinks, it is usually wiser to plan for an office interview. The 
elements necessary to make an interview successful are privacy, 



156 The Annals of the American Academy 

lack of interruptions, feeling of freedom, candor, openness and 
plenty of time. In the office the worker can better control the 
situation to include these desired elements and can also bring the 
interview to a close at the psychological moment. The atmosphere 
there is more conducive to coming to conclusions. The drinker, if 
he is a man, must feel the thrill in carrying out an agreement made 
in a business-like manner. His pride is aroused. He feels in a 
very real sense that he is chiefly responsible. Such a sense of 
responsibiUty, strengthened by simple encouragement from some- 
one in whom the client has confidence, is one of the most potent 
factors in success. 

A vital principle in working with individuals who drink, as in 
other forms of case work, is to work with the individuals in question, 
allowing them every opportunity to express their own opinion as to 
the difficulties in which we find them and helping them to make 
their plan for the future. Our treatment should as far as possible 
be based on their plan, or if we cannot accept their plan, we should 
make every effort to lead them to our plan so gradually and care- 
fully that it becomes their own. The following will illustrate: 

In the past we had been good friends of the G. family. We had not seen 
them in some time, however, till Mr. G. came in of his own accord to tell us about 
the days of hard drinking which had preceded his waking up to find his family 
literally broken up and separated. When asked his plan for the future, he shot 
back a reply which showed that his experience had really touched him, and that 
it had vitalized him into making a plan to which he had mentally committed 
himself. Its chief elements were change of habit, a new routine of life and the 
objective of a reconstructed home. His wife, broken down from overwork and 
worry, was in a hospital. His children had been taken by the S. P. C. C. Be- 
cause he felt that the responsibility was all his, he wanted to start off immediately 
trying to rectify his errors. His plan was sound in every resf)ect and we co- 
operated with him to the end of making it possible for him to succeed. 

In the case of Mr. B., his plan included the breaking up of his own home, hav- 
ing his wife committed through court for a cure, having the S. P. C. C. take his 
children in order to bring his wife to a realization of her responsibilities and oppor- 
tunities and banishing himself and his oldest son to a furnished room life until 
the family could be re&stablished on a firm foundation. Getting Mr. B. to put 
into words the long road ahead of him was perhaps the biggest possible help 
both to himself and to the case worker. 

In making our plans for the individual who drinks, we find two 
possible lines of action, care at home or institutional treatment. 
Before we decide on either course of action, we want to have our 



Alcohol and Social Case ^^'oRK 157 

facts vei-y clearly in mind. In his Report of the Inspector under 
the Inebriates Act for the Year 1909, Mr. Branthwaite places every 
alcohol user in one of three groups. They are as follows: 

1. Tlu> occasional drinkor, thoso who ,'iio are strictly niodonite in their 

indulgence. 
1!. The free drinker or ocoa.sional linmkard, those wlio drink more freely than 

is consistent with strict moderation or who arc occasionally drunken. 
3. The habitual drunkard or inebriate, those who are habitually drunken or 

beins: usually sober, arc subject to occasional outbui-sts of uncontrollable 

drunkenness. 

It is tlie individuals who fall in the first two classifications who 
give us our best opportunity for care at home. This plan of treat- 
ment undoubtedly has some disadvantages which must be realized 
at the outset. For example, we are hampered in a large city, no 
less than in a small community, by the attitude of the pubhc towai'ds 
the persons who are trying to cure themselves at home. On the one 
hand, there is tlie public which sentimentalizes: on the otJaer, the 
public which is hai'sh and sees no hope for the drinker. Both of 
these attitudes are manifestly unfair to the individual; we must 
seek to educate the pubUc, on the one hand asking people to give the 
individual a chance, on the other, expecting tliem to hold the in- 
dividual up to standai'ds, to demand of liim that he attain the best 
of which he is capable. There are, on the other hand, undoubted 
advantages in home caxe of which we must take account. Among 
otlier things, the indi\'idual's pride and self-respect are saved; there 
has been less of a break with the past, there ai-e fewer explanations 
and apologies to be made. This appUes especialh- in regard to the 
children of our client, pai'ticularly the younger ones. Above all, if 
the individual can remain in the home and continue in tlie support 
or care of the family, the psychological effect is very great. Such a 
coui-se of action builds up self-confidence and self-respect, both of 
which are vitally important. 

Weighing the advantages against the disadvantages, we still 
can not choose liome care unless we are sure of otlier facts. Is such 
a plan conducive to the welfare of tJie family as a whole or will the 
family life be materially injured? Furtiier we must be sm^ of the 
sincerity of our cheiit in his effort to get hold of liimself and we must 
be sure that we can direct his plans, if not actually control them. 
"We must be sure tJiat we have the needed resources to make home 



158 The Annals of the American Academy 

care a success in the given case. First among such resources is the 
proper medical care. It is vital that from the outset we know the 
physical condition of our client in order that we may build up his or 
her health in every possible way. The plan of a good physician for 
sound health must be the foundation stone on which we build up 
our other plans for treatment. Special medical treatment may also 
be used, depending upon the needs of the patient. Mr. Bran- 
thwaite, however, does not believe that any of the cures for alcohol 
have an inherent value. If the patient believes that the drug will 
cure him, then by all means try it. This beUef will strengthen his 
will. Other resources sometimes tried are suggestive therapeutics, 
electrical treatment, hypnotic suggestion and religious influence. 
With some this latter may be a strong help; with others the gospel 
mission may do better work.' Above all, interesting and remunera- 
tive work and relaxing diversions are invaluable. All these re- 
sources may be tried in the effort to gain our end which is the 
ability of the individual to break his past habits and to establish 
self-control. "There may be more control there than anyone 
thinks," says Branthwaite. "Awake the dormant self-control." 

It is the persons who fall in the third classification above quoted 
who constitute the group for whom institutional care is most often 
needed. It is therefore essential to have clearly in mind the char- 
acteristics of this group. Dr. Irwin H. Neff of the Norfolk State 
Hospital, Massachusetts, say that inebriety is an expression of 
nervous weakness and that upon this weakness is founded a habit 
which we call drunkenness. In other words, there is in the inebriate 
a definite pathological condition which predisposes him to an e;xces- 
sive use of alcohol if he drinks at all. It is possible that inebriety 
may be acquired by long continued indulgence but usually inebriety 
is inherited as a nervous condition, remaining latent or becoming 
evident according to circumstances of habit and. environment. Dr. 
Neff concludes that inebriety is a definite disease and must be 
treated as such, although much can be done along the line of estab- 
lishing new habits and by personal influence as in the case of both 
the occasional drinker and free drinker. Because there is a definite 
pathological condition in the case of the inebriate, his or her only 
hope lies in having the possibility of drinking entirely removed, at 

' For a brief discussion of the value of gospel mission, see American Red 
Cross Publication 200, July 16, 1917, pp. 41 and 42. 



Alcohol and Social Case Work 159 

least temporarily. It is for this reason that institutional care (in- 
cluding farm colonies) is advisable for this type of clients. The 
place of institutional care in the treatment of inebriety has been so 
well covered in the article on "The Practical Treatment of Inebrity 
in a State Institution" by Irwin H. Neff^ as to make further dis- 
cussion unnecessary here. The reader will there find a full discus- 
sion of after care in which work all the skill of the finest type of social 
case work is involved. 

In all types of cases in which drink is a factor, be they the occa- 
sional drinker, the free drinker or the inebriate, it is essential that 
there should be given to the man a definite objective in life to help 
him overcome his battle with drink. This objective must be chosen 
with a full knowledge of the possibilities of the individual and must 
never be beyond his reach. It is needless to add that the objective 
should be such as to call forth the very best efforts of the client, 
awakening his imagination and arousing him to a new life. 

2 Proceedings of the National Conference of Charities and Corection, 1915, 
pp. 396-407. 



THE IMMIGRANT FAMILY 

By Eva W. White, 
Director, The Extended Use of the Public Schools, Boston. 

The test of a good case worker is found in the many-sided field 
of social treatment as it relates to the immigrant. Not only is high 
skill demanded in analyzing personal diflSculties but a knowledge 
of the customs and traditions as well as the inner hopes and aspira- 
tions of the immigrant is also imperative. 

It is agreed that only a beginning has been made in social 
diagnosis in general, but it is not so certain that the same htmibleness 
of spirit exists in regard to the plotting of a plan of action in relation 
to our foreign residents. Else why are so many philanthropic 
organizations found in immigrant communities still carrying on their 
case work in the rudimentary, undifferentiated fashion of consider- 
ing certain human traits to be so basic that reactions are identical 
whether a man be a Russian or an Armenian, a French Canadian 
or a Pole? Societies recognize the fine gradations of analysis that 
are coming to be required in getting at the variations of mental 
power and of manual aptness. They draw on the knowledge of the 
psychiatrist, the psychologist, the vocational coimselor, and yet 
most of these same societies meet the problems of the immigrant 
apparently in complete innocence as to the play of dominant racial 
experiences. 

There has been a curious lapse in this respect in the building up 
of case work technique. In going about the country- the writer has 
been interested in inquiring in regard to this question of speciaUza- 
tion in case work for the immigrant and it would assist the general 
cause considerably if readers of this article would do the same. It 
will be found that in the majority of our large industrial areas where 
the issues, both personal and social, are intense, as well as in many 
of the foreign sections in our cities, organization after organization 
is functioning almost exactly as it would function in an American- 
born community. Two or three of the more important members of 
the nationalities living in the towns or districts of cities may serve 
on committees or boards of management and interpreters may be 

160 



The Immigrant Family 161 

used, but the executives who are intrusted with leadership will be 
found far too often to have had no experience that fits them to under- 
stand European customs. They have neither traveled abroad 
nor resided in local foreign colonies, and often they are amazingly 
lacking in an intelligent grasp of the fundamental issues involved in 
the adaptation of the personnel of their districts to the require- 
ments of American living. Maximum results in the way of assisting 
the immigrant and his family will never be obtained so long as this 
holds true, nor will the community be stimulated as it should be. 

It must be said to the credit of social work that in certain of its 
branches it has shot ahead of education. Americanization societies, 
immigrant protective leagues, and travelers' aid groups have shown 
how inadequate school work for immigrants has been and is. Cruel 
as much of the hyphenated American propaganda was, it roused the 
country into realizing what it had not done and an important part 
of the national defense program is now concerned in working for the 
best interests of the immigrant and, therefore, of ourselves. Night 
school procedure is gradually changing. Day classes in English and 
in other branches of study are operated for the benefit of night 
workers. Far greater attention is paid to instructing the non-English 
speaking mother. The schools are throwing their doors wide open 
for lectures, forums, civic clubs and discussion groups, as well as 
for musical Societies, so that the thought life may be expressed and 
the refining elements of dormant art consciousness may be developed 
and brought out. 

Larger Aspects op Case Work 

The war has caused the question of immigration to be faced 
squarely, and every social, civic or philanthropic society that has had 
to do with the immigrant should take account of stock. The argu- 
ments pro and con for immigration are many. Economists take 
sides; the sociologists are not in one camp; those who are interested 
in political science are found to be divided. Among the general 
citizenship are those who believe in restricting immigration and those 
who do not. Where do the social workers stand? Sentiment, in- 
tuition, generalizations by only a few observers over only short 
periods of time will not help. Massed experience in which the varied 
elements of physical standard, mental power, industrial success, 
political effectiveness and ethical outlook are gauged not as sepa- 

12 



162 The Annals of the American Academy 

rate ends in themselves nor through abstraction but in the blend of 
personalities known, is the contribution demanded of social workers. 
Social workers may well ask whether their case work is in the hands 
of persons with the requisite breadth of understanding. Is case 
work so organized as to give the necessary data? Is the range of 
contact of secretaries such as to enable these data to be interpreted 
in their relatedness, not merely from the point of view of the indi- 
vidual but in order to contribute to problems such as the immigrant 
and labor, the immigrant and the race stock? These are some of the 
larger aspects of case work. 

It is not the object of this paper to stand as an essay for or 
against any of these opinions on immigration but rather to point out 
that the case worker who does day to day work in immigrant com- 
munities and who is not viewing each day's experience as material 
to assist in the shaping of public policy toward the alien, not only 
negates social work but also becomes a deterrent factor in the prog- 
ress of our knowledge of a subject which has untold influence on the 
future of America. 

' No society should be satisfied with a worker whose results are 
merely tabulated by jobs found, medical assistance given, or the 
number of children's difficulties that have been straightened out. 
A certain proportion of successful results is to be taken for granted 
by any one who has been trained for availing.. Efficiency comes 
from what is played up out of personal contacts. Here is where a 
case worker falls down unless the tangled scope of the immigration 
problem is clearly sensed and unless the bristling questions that are 
being faced by outlying sciences as they play into the field of social 
work are understood well enough to be tested by each individual 
need of family necessity. 

For example, what policy does the worker advocate in regard 
to industrial adjustment as a result of experience with out-of-work 
cases? How do the immigrant cases differ from similar cases which 
involve the American-born? What is the statistical comparison of 
disease between a given race and the American-born? If the immi- 
grant is more resistant than the native-born, why? If less resistant, 
why? Do local case histories tally with available statistical ma- 
terial? If not, why? A contribution may be lurking in such a 
search for fact within the range of the sphere of the case worker. 



The Immigrant Family 163 

Proper Qualifications for Case Workers 

Granted that this interplay between the actual needs of men 
and women is known and that the issues involved affecting our 
social structure are recognized; granted that the method is adopted 
of analyzing each person's difficulties in the light of the group prob- 
lems of a given nationality; and granted finally that so wide a re- 
sponsibility is assumed as that of attacking such an assumption as 
national deterioration in the light of local knowledge, — a question 
still arises as to the qualifications and training of persons who are to 
serve public and private agencies in the field of action of the immi- 
grant. As to the personal qualifications of a worker with immi- 
grants, certainly there should be no ray of prejudice. The worker 
who is so caught by the romance of difference as to see every immi- 
grant problem in high fights is quite as much against the cause of 
the immigrant as the one who cannot shake off the shackles of 
Anglo-Saxon provincialism. In other words, the balanced, scien- 
tific mind that searches and waits is of importance : not, however, 
the scientific mind of the recluse but of the individual who lives with 
men. 

Absolute science plays its part on the elemental plane; beyond 
are all those ranges of thought and association which make our 
civilization, the change of emphasis of which can only be known by 
close contact with people. If it be permitted to recoginze tempera- 
ment, a social worker with immigrants, more even than those in 
other fields, should have that intangible power of winning confidence 
and of rousing belief in self which breaks down all barriers and 
brings about understanding on the basis of human nature. This 
is especially important in the case of a worker whose race stock is 
different from the race stock of the community which is served. 

This leads to a mooted point. Which will do the better, a per- 
son whose parentage reaches, back far enough to be considered a real 
product of our country or one who, if not an Americanized immi- 
grant, was born in this coimtry of immigrant parents? If it were 
positively stated that only Italians should work among Itafians, 
Bohemians among Bohemians, such a statement would be far 
afield. This error is made by certain societies organized on a racial 
basis . On the other hand, society after society in this country is crip- 
pled because the staff is made up of persons with no affiUations with 



164 The Annals of the American Academy 

the racial groups among which they are working. The fact of the 
matter is that a member of a given race has certain marked advan- 
tages over a person not of that race. The ability to talk freely in a 
mutually understood language, appreciation of a common tradition, 
the understanding of racial or religious customs, are tremendously 
important and are of immediate advantage in the first days of con- 
fusion and inquiry when the immigrant arrives in this country. 
As soon as the immigrant has gained a footing, however, another 
consideration enters in and that is the obligation to bring the immi- 
grant into such contact with Americans and American ways as will 
lead to an appreciation of the American outlook. 

The history of the Slavs has made the Slav. The history back 
of America has made the American. It is incumbent upon us that 
we understand those who come from Europe. It is equally neces- 
sary that they appreciate the type of person born and bred here for 
generations and reared under our institutions. This is fair play and 
the faults of both in relation to our coimtry can only be eradicated 
by mutual cooperative effort based on imder standing; and this can- 
not be brought about at arm's length. Therefore, the person of 
American descent whose background of experience justifies the claim 
of understanding the alien, has a place on the staff of societies organ- 
ized to assist the immigrant. 

When residents of a locality take the attitude that no straight 
American should be engaged in their district, they are to be con- 
demned as missiiig an opportunity, not only directly for themselves 
but also in the way of interpreting their contribution to that larger 
circle called the public on whom after all their welfare depends. 
The ideal combination of workers would include both persons who 
have immigrant ties and those who have not. Under no considera- 
tion should a person be made a secretary for the mereTeason that it 
is thought advisable to have a representative of a certain racial group 
on the staff for that reason alone. Standards of efficiency have too 
often been let down when it was decided to appoint persons who are 
members of alien groups so that truly representative agents have not 
been chosen. The foreign-speaking agent should have inborn 
qualities of a high order and should serve an apprenticeship over a 
period of time long enough to know well the resources of a com- 
munity. Certainly no novice should ever be plunged into an immi- 
grant district. A secretary not of European parentage should not 



The Immigrant Family 165 

■only have a wide range of experience in case work but also the asset 
of long-term residence in a foreign colony in order to appreciate the 
norm of a race and also in order to know the special difficulties the 
immigrant meets with in this country. This subtle vmderstanding 
does not come in one week or two. 

The training of a case worker among immigrants should be con- 
•cerned not only with the usual methods of social diagnosis and treat- 
ment but with the working of the institutions that have been or- 
ganized particularly for immigrants. The operation of -our laws 
should be studied and tested. What public officials can and cannot 
do should be known. No one should begin to do case work among 
immigrants who is not thoroughly familiar with the method by 
which aliens are admitted into this country and guided to their 
destinations ; with the operation of the courts as they affect the im- 
migrant ; with the steps that lead to citizenship ; with the employ- 
ment offices as they serve in getting work. The weak and strong 
points of both public and provate agencies must be known and a per- 
son should have become expert in using available resources or in 
supplementing the same before an appointment as an executive can 
be expected. 

Types of Immigrant Problems 

Compared with case work in the main, individual and family 
immigrant problems that an agency is called upon to face are not of 
the degenerative type. The immigrant gets into trouble and needs 
assistance most often because of a failure to understand American 
requirements or because of imperfect adaptation to our conditions. 
Of course, certain immigrants drink to excess. Of course, there are 
the shiftless among them as well as those who neglect their homes 
and those who fail to go forward. Sickness, too, plays its part in 
our case work for the immigrant. In general, however, it can be 
taken as a fair presumption that the needs of immigrants who 
apply for aid can be discovered with comparative ease and that the 
proportion of successful results to failures will be high. This 
statement should not for a moment be taken as inferring that our 
native stock presents more difficulties or difficulties of a kind that do 
not yield to ready solution, but it must be frankly admitted that 
those who are native bred will not go to a charity except as a last 
step. 



166 The Annals of the American Academy 

On the other hand, the immigrant tends to turn to local agen- 
cies for assistance for no other reason than to be sure that the right 
track has been chosen. This is more and more true now that the 
races coming to us are finding us far different from themselves. The 
immigrant arrives with a humble trust in the helpful personal in- 
terest of Americans. Even police officers are often asked to decide 
upon the most intimate matters of family policy. In short, a 
worker among immigrants can take it for granted that an immigrant 
in entering an office has come for information or guidance as such, 
that there is no drag of personal weakness or broken ties of family 
or group to be faced in the majority of instances. 

An illustration. A man out of work and physically run down had been work- 
ing as an unskilled helper in a factory. Wages at the time he was interviewed 
were $2.50 per day. He had been in the United States two years and said he had 
been a draftsman in Europe. The man was given a pencil and to the surprise of 
the agent drew the picture of a cottage in which he had lived in Italy and when 
asked how the rooms were arranged in the cottage, drew a floor plan. The man 
was asked if he was in need of money. He replied that he was not but he was 
greatly worried because he would be in a couple of weeks. He said he had heard 
that the agent could help him to get another position where his work would not be 
as hard. 

Action on the case. An appointment was made with an Italian physician who 
reported that the man needed rest and that he was unstrung nervously because he 
did not like his work which had been too heavy for him. An architect was tele- 
phoned to. By a stroke of good fortune he said he would see the man. 

Result. Eight (8) years from that date, the family was living in a suburban 
home which was being paid for through a cooperative bank. 

It is to be noted in connection with this case that ■ very few 
questions were asked. The record might be considered incomplete, 
yet certainly^the art of a good case worker consists in knowing what 
not to ask quite as much as what to ask. With immigrants it is of 
prime importance that their confidence be won. Great care should 
be taken not to cause self -consciousness through too close an inquiry 
into personal affairs. Many an immigrant has been turned aside 
by too incisive a method on the part of case workers, and the un- 
cooperative attitude of immigrants who have been in this country 
for a time is undoubtedly due to prejudice engendered by the lack 
of appreciation by an agent of the need of care in a first approach. 
It would be a fair guess to state that societies in which immigrant 
needs factor largely, will testify that 90 per cent of their cases will 
revolve around such matters as advice regarding where work can be 



The Immigrant Family 167 

found, or better jobs obtained; questions as to our savings institu- 
tions; problems involving their own desire to learn English and to 
educate their children; matters concerned with sending for rela- 
tives or getting in touch with members of their families who are 
supposed to have arrived in this country or are expected; questions 
in regard to becoming citizens and matters which concern medical 
care. Immigrants need to be told where to go for work and to be 
put in touch with the leaders of their race who can be trusted. 
They need to be directed to public agencies that will assist them, 
such as immigration bureaus, night schools and recreation centers, 
and the skill with which this is accomplished means everything for 
the future of those who come to us. Every inquiry carries with it 
the responsibility of so answering that the immigrant leaves with a 
clear understanding of the matter in which 'he is interested and feel- 
ing encouraged to return if again puzzled. 

Enough has been said to make the point that in immigrant 
case work more frequently than not the problem is one of putting 
persons in touch with resources that are unknown to them. The 
immigrant comes to us strong, eager, ambitious. Give him a 
chance and he will do the rest. Difficult personal idiosyncrasies 
do not play a large part in case work with the alien nor jdoes family 
discord. Would that the same were true of the second generation! 

The Second Genebation of Immigrants 

Our contact with the immigrant straight from the old country 
convinces us that he is seldom unable to care for himself. His 
children, however, are found on our relief lists and in the ranks of the 
unemployed to too large an extent. No fair-minded person can lay 
this fact to anything other than our own American neglect. Two 
Unes of effort open up here for the case worker. 

First: a far more refined fitting of individual ability to op- 
portunity than has been carried out and a more drastic attack on 
certain environmental conditions which weigh heavily upon the 
immigrant. At present the immigrant is fed into industry as noth- 
ing more than a unit of man power. The time is approaching when 
the government employment agency will use the vocational method 
of considering special aptitudes for particular jobs. Immigration 
brings in a mass of unskilled labor it is true, but there have been 
hundreds of instances of men whose skill as machinists or craftsmen 



168 The Annals of the American Academy 

has been wasted because they have not known where to go for guid- 
ance or because an employment agency has not taken the pains to con- 
sider anything but the fact that a man needed work and that any 
job would do. 

Not only are the government employment agencies moving on 
toward the point of greater care in classifying workers, but industry 
itself is concentrating on lessening the labor turnover and is engaging 
persons to test out special abihty. 

Further, considering the European environment from which 
certain of our immigrant groups come, it is essential that we get 
those with an agricultural bent out on to the land. Although some 
gain has been made in this matter of distribution during the past 
few years, we have only begun to attack the problem so that the 
case worker with immigrants will find a fertile field in this direction 
for individual suggestion and individual encouragement. 

Case work records of an agency tell their own story of difficulty. 
They present the effects of heredity, the overpowering result of dis- 
organized family life and the insuperable difficulties of environ- 
mental conditions. With the immigrant we find not so much difficul- 
ties of heredity as lowered family unity. We find bad housing, the 
evils of congested areas and industrial exploitation playing their 
part in breaking down the natural mental power, moral rectitude 
and physical tone of the immigrant. Since this is true, efforts to 
assist individuals stand indicted unless, coupled with these, case 
workers use every means for attacking environmental handicaps. 

A native of this country is often not in close enough touch with 
European family standards to realize fully how very important it 
is to go back continually to the family relationship in given indi^^dual 
difficulties or in thinking out a plan of action for a boy or girl, man or 
woman. Two extremes are often faced in immigrant situations: the 
instances where persons have no relatives in this country^ and 
so are free from all family restraints, and the instances where fam- 
ily dominance is so strong as completely to submerge the individual 
and create an almost insuperable obstacle to necessary freedom of 
action. 

The case worker should work sympathetically with the latter 
situation, remembering how important a part the family has played 
in the history of certain foreign races and in a negative way reason- 
ing back from forms of anti-social traits which, particularly in 



The Immigrant Family 169 

young people, develop because parental respect and the ideal of 
the home circle has broken down. The family ceremonial should be 
honored and interpreted to our young foreign citizens in its Ameri- 
can setting. 

Important Factors in the Problem 

It is never safe in any form of problem not to reason from the 
physical, mental and the moral responsibilities of a person back to 
assets or defects in family situations as well as to consider the Jielps 
or handicaps that may spring from association. With the immigrant 
the surrounding groups of which he is one are all important. Custom 
has at once a binding effect which may need to be modified and at 
the same time a protective influence that must be brought to bear 
on many a situation, and in this regard no two nations are alike. 
There is all the variation of temperamental reactions as well as tra- 
ditional code. A case worker is treading on dangerous ground un- 
less these distinctions are recognized. 

With a person who has no family ties, the building up of ac- 
quaintanceships among those who have enough at stake in a neigh- 
borhood to be acted upon by public opinion cannot be brought 
about too quickly. It is moi'e and more coming to be accepted that 
the judgment of one's peers acts as a centripetal force in holding one 
up to accepted standards of thought and action. When persons 
are free from the obligations of family and are outside the pale of 
the effect of community requirements, a decidedly unnatural situa- 
tion is created. Example after example could be given where the 
building up of community ties has swung persons from danger into 
resistant self-assertion. 

By way of summary we may say that aside from the usual iden- 
tifying data of the name, address, et cetera, which need not be de- 
tailed here, it is essential not only to get the country from which a 
person comes but also the section of the country. Occupational 
circumstances should be gone into carefully since in many parts of 
Europe lines of work may be similar to lines of work here and yet 
vary greatly as to the technical requirements and the conditions 
under which labor is carried on. 

Moreover, it is not always safe to assume that an immigrant is 
uneducated, in its broadest meaning, even though he may have had 
little schooling. In certain sections, the folk organizations of the 



170 The Annals op the American Academy 

people have for many years been such as to develop a depth of 
thought and a sort of philosophy, to say nothing of a practical 
kind of reasoning. Only a limited training in symbols of languages 
is needed to remove such a person far from the illiterate group. It 
must be remembered, too, that the importance of the church varies 
markedly in certain parts of Europe. 

Oae of the most important considerations is getting at the reason 
why the person came to this country. These factors are extremely 
important in helping to bring out the right kind of assets in a case of 
need or to make possible connections with persons who would be 
willing to extend the advantages of good fellowship to a stranger or 
to connect a person with any of our organized forces of civic or 
social life. 

In facing any given problem one reasons first in terms of the 
power of the individual. What has he within himself? What has 
been given him by nature? What has been added by training? 
What does he possess in the way of experience and how does he fit 
into his circle of associates? Then, what is there in the family sit- 
uation which will push him forward or draw him back? What does 
the community offer in the way of giving play to the possibilities 
made apparent by these two lines of deduction? 



THE SOLDIERS' AND SAILORS' FAMILIES 

By W. Frank Persons, 
Director General of Civilian Relief, the American Red Cross. 

Although in the very nature of the case, soldiers and sailors are 
separated from their families, the Home Service of the American 
Red Cross reaches both the men, wherever they may be, and their 
loved ones at home. It is at once the means of sustaining the spirits 
of our fighting men and of preserving the welfare of their families. 
It is a tie that binds them together. Men may be the best soldiers 
in the world, but if things are not well with their families at home 
they lose efficiency through worry, and. the morale of the army — 
that all-important factor — begins to fail. 

So it is the patriotic duty as well as the humanitarian oppor- 
tunity of Home Service workers of the American Red Cross to care 
for the lonely famihes of our fighting men. They must be en- 
couraged to " carry on " without faltering. Their families must not 
be allowed to bear personal privation and so to double the willing 
sacrifices they have made. Every report from the training camps 
and from the French front mentions the excellent spirit of our troops. 
Will they maintain this morale while thousands of miles from home, 
through trench-life and battle, to the victorious end? The answer 
will be determined largely by the Home Service of the Red Cross, 
which must be the nation's assurance that no enhsted man's family 
will suffer for any essential thing that Hes within its power to give. 

There are representatives of the Home Service of the Red Cross 
in every training camp for soldiers and sailors in this country; they are 
with our troops in France; and their offer of help is on the bulletin- 
board of every ship of the Navy. They invite the confidence of 
the men, and win and deserve it. They learn of the anxieties of 
the enlisted men and of needs in their homes. Such messages are 
then pronrptly sent to the Home Service Sections of the Red Cross 
Chapters and their famihes are visited and helped. Then the en- 
couraging news goes back t6 the husband or brother. He also is 
helped. That result is not hidden from those on this side the 
trenches. Daily letters are received like the following: 

171 



172 The Annals of the American Academy 

Camp 



December 10, 1917. 
To the American Red Cross: 

I wish to extend my sincere tlianks to you for going to aid my wife and child 
whom I asked you to help last week. My wife wrote me that you came to see 
her. I highly appreciate that. / can soldier better now. 

Yours sincerely, 



No argument is necessary to show that Home Service must 

give the assurance that the soldier and sailor must have, if he is to 

, do his best,— the assurance that in trouble or misfortune the Red 

Cross will do what he would do if he were at home instead of at 

the front or on the sea. 

The Home Service of the Red Cross may assistr through morale, 
to shorten the conflict and so to lessen the consequences of battle, 
but it may do even more to save the social consequences of war at 
home. It may protect the homes left lonely and unprepared for 
emergencies; bring comfort and cheer to the homes left in anxiety 
and privation; safeguard the health of women and children; uphold 
the standards of child care, of working conditions and of recreation 
and education. So far as is hunjanly possible it may help to main- 
tain the essential standards of home life, so that when the soldiers 
and sailors return from the war, their families shall be found ready 
to help and to encourage them to honor further the country which 
they have so nobly served. Nothing less than this will measure 
up to American ideals, and on these ideals the Red Cross has founded 
its conception and its plans for Home Service. 

Oppobtunities op Home Service 

Home Service is not relief in the sense of money payments or 
doles of food or clothing, though such assistance may be necessary 
even to the families of soldiers and sailors. The enactment of the 
War Risk Insurance Law, heartily advocated by the Red Cross, has 
placed the responsibiUty for financial aid in large measure upon the 
government, where it justly belongs. The provisions of that act 
make liberal money allowances to the families of men in the armed 
service. These allowances do not diminish but rather multiply 
the opportunities for usefulness of Home Service, though these were 
manifold before allowances were granted. Home Service is now 
able to turn its full power upon its own real task. 



Soldiers' and Sailors' Families 173 

The greatest opportunity of Home Service lies in conserving, 
liutaan resources in the famiUes left behind. The majority of these 
famihes are in position to maintain good standards of health, edu- 
cation, industry, and family solidarity without recourse to outside 
help of any kind. A considerable minority, on the other hand, find 
their powers of self-helpfulness strained to the breaking point by 
lack of opportunity, by ill health, or by the sudden changes in their 
way of living brought about directly by war conditions. In no 
instance must the standards and ideals of home life be lowered. 
The social consequences of war must be anticipated and all ten- 
dency to deterioration must be checked. 

The second opportunity for Home Service, for which the 
government in the very nature of things cannot make provision, 
is relief in emergencies, such as temporary financial aid while legal 
claims are being adjusted, or while, the receipt of a government 
allowance is delayed. The chief requirement here is promptness. 
This kind of service has not been a heavy burden, although the 
Red Cross Home Service undertook it during the first seven months 
of the war when there were no government allowances. In every 
instance Home Service is careful to continue its relations of confi- 
dence and friendship with the families it has aided in this way and 
to conserve the welfare of these families in every possible manner. 

The third opportunity, like the first, will be not only a con- 
tinuing but an increasing one. It is the giving of regular allowances 
when needed, to those who have no legal claim to the federal allow- 
ances, but a moral claim to Red Cross interest, owing to the fact 
that they have been accustomed to depend upon men now in the 
service. Another large group, who have no legal claim oa the 
United States government but who have been formally accepted by 
the Red Cross as a special responsibility, are the famihes resident in 
the United States of men who are in the armies or navies of our allies. 
This is no small matter. On Manhattan Island there are many hun- 
dreds of these families receiving Home Service. It is the aim 'of 
Home Service to discharge scrupulously in each community this duty 
to the families whose men are fighting side by side with our own. 

The fourth opportunity for Home Service will increase in im- 
portance with each month that our forces are engaged in actual war- 
fare. It relates to the returning soldier or sailor, more especially 
when he returns disabled. Whatever can be done through special- 



174 The Annals of the American Academy 

ized hospital and institutional treatment will be done by the govern- 
ment, supplemented so far as may be appropriate by the Red Cross 
and by other agencies. The supremely important thing is the pre- 
vention of permanent disability. In this, many forces must co- 
operate. In so far as these forces are local, Home Service will have 
to carry forward the work begun in government hospitals and 
training shops. The non-institutional side, the readjustment to 
actual home conditions, the fitting of men back into industry after 
discharge, the interesting of individual employers^ the organizing 
of local resources for further training, and the development of a 
helpful and stimulating attitude towards these men throughout the 
whole community, — these are recognized as definite Home Service 
tasks. It is not merely a just, humanitarian service to individuals, 
but also a duty to the country, to put forth every effort to conserve 
the energies of partially disabled soldiers and sailors, and to read- 
just them to civilian and industrial life. 

The fifth opportunity for Home Service lies in the desire of 
relatives of enlisted men for information of many kinds. Already 
this service is widely extended through Home Service advising how 
mail should be addressed to soldiers and sailors; how information 
may be obtained concerning those sick, wounded, or missing; what 
the Wiar Risk Insurance Law means and how to take advantage of 
its provisions. This work is being constantly extended and is 
saving untold anxiety and suffering. It will serve furthermore in 
a very substantial way to maintain the comfort and health of those 
families who have given their breadwinners and protectors to the 
service of their country. 

Finally, a sixth opportunity for Home Service is to help families 
to keep pace, in ambition and achievement, with the man who is 
surrounded, often, with new chances for education and advancement. 
The growing importance of this work is realized by Home Service 
workers. Men who have had but limited opportunities in life are 
suddenly obliged to travel, to accept mental discipline as well as 
military discipline, and to associate with men such as they have 
never met before in close contact. And they are advancing. For 
example, one Home Service Section is now caring for the large 
family of a naturalized citizen who voluntarily enlisted as a private 
but who is already top sergeant. He has made good in remarkable 
fashion. If he should return home to find his family in the same 



Soldiers' and Sailors' Families 175 

forbidding home life in which he left them, he would most surely be 
disheartened and discouraged. So the Home Service worker has 
moved the family to pleasant comfortable/ quarters. The wife and 
children have now the recreation and advantages which will in- 
sure a home life worthy of this soldier's ideals when he comes back. 

Organization 

Concerning the organization of the Red Cross for Home Service, 
perhaps it is sufficient to say that the work is organized in each lo- 
cality as a separate, distinct activity of the local Red Cross Chapter. 
As a part of the Civilian Rehef Committee of the Chapter, there is 
constituted a Home Service Section whose membership is as repre- 
sentative as possible of various local interests — business, profes- 
sional, church and social work. The .Home Service Section is 
responsible to the officers of the Chapter for the proper conduct 
of its work in behalf of the families under its care. It decides mat- 
ters of policy as to its own work; prepares and submits the budget 
, required for carrying on its activity; employs the clerical and visiting 
staff; enlists its volunteers; organizes its office system and makes 
its own required reports to the Chapter and to the Department of 
Civilian ReUef. Where the work is considerable, a Consultation 
Committee is appointed which includes persons engaged locally in 
public health work and social service, and others with special ex- 
perience and knowledge of local social conditions. If possible there 
is also appointed someone familiar with the military and naval af- 
fairs, who can advise the Section concerning proper procedure in 
such matters. There is also usually appointed a lawyer who can 
instruct the Home Service workers about municipal and state laws. 
The principal function of the Consultation Committee is to con- 
sider difficult problems which arise in the course of work with in- 
dividual fainiUes. It is designed to facilitate cooperation between 
the Red Cross and the agencies and persons regularly engaged in 
family work. 

Each Home Service Section draws its budget from the funds 
of its Chapter, raised locally, the responsibility for raising funds for 
Home Service resting with the Finance Committee of the Chapter. 
There is the minimum of red tape and formality, the minimum of 
control so far as the Department of Civilian ReUef in Washington 
is concerned. 



176 The Annals of the American Academy 

It is the purpose of the Red Cross Home Service that each 
Chapter shall have such a Home Service Section, no matter how 
few men may have entered the service from its territory and no 
matter how self-sufficient their families may appear to be. By 
no other means can the responsibility for Home Service be fixed. 
The Home Service Section in each community is much more apt to 
have the cooperation of local social agencies, and to enlist the ini- 
tiative, the cordial spirit, and the sympathy in fullest measure 
of the neighbors and friends of soldiers' and sailors' families, if the 
responsibility for organization and direction of this work remains in 
local hands. Without a group charged with this responsibility for 
Home Service, there wiU be soldiers' children dropping out of school 
or deprived of timely medical treatment; there will be soldiers' 
wives wheedled out of their income by shrewd agents or cheated out 
of it by fakers; and there will be soldiers' homes broken up during 
their absence by misfortune of one kind or another which the strong 
will and informed mind of a friend at hand might have overcome. 
Ten families have just as much right to Home Service as have one 
hundred families. It is not the volume but the character of the 
work that counts. 

How Home Service Learns Where Help is Needed 

Home Service endeavors to be very careful about the method 
of approach to these families. It is not intended or permitted that 
all families of soldiers and sailors shall be called upon, and asked 
if they require assistance. No home is to be visited in the name of 
Home Service without a definite invitation from the family or from 
some responsibile person competent to speak for them. Home 
Service has no desire to intrude or to expose people to comment. 
For this reason, the wearing of a specialcostiune by Home Service 
workers has been discouraged; for this reason also, unconfirmed, 
anonymous requests to visit families are ignored, though each such 
request is made a matter of record. It is purposed that the work 
of the Home Service Section be so well understood, and its work so 
natural and neighborly, that those who need help of any kind will 
be drawn to avail themselves of it. There are many ways, of course, 
in which the Home Service worker may come into contact with 
these families. 

At every camp and cantonment the Home Service Director, 



Soldiers' and Sailors' Families 177 

who everywhere enjoys the fullest support and approval of the 
military authorities, takes every means to let the men know of this 
phase of Red Cross work. Sailors on every vessel of the Navy get 
the message. Many requests come from soldiers and sailors 
through such pubhcity. Through publicity in the local press, 
and through their friends, Home Service comes to the attention of 
other members of the soldier's or sailor's family who may ask help 
for the wife or the mother of the household. These have been very- 
frequent means of approach to those who have needed assistance. 

Home Service Sections learn of emergencies in families, and 
find ways of offering help, in the natural course of fulfilling the 
Information Service which has proved to be one of its great op- 
portunities. Helpful relations have been established with famihes 
in which there were children, by securing the assistance of school 
teachers to whom the aims and the scope of Home Service are being 
everywhere explained, not by general circularizing but in quieter 
ways which have resulted in mutual understanding and the secur- 
ing of prompt information about children who are wayward or sick 
or neglected, or withdrawn from school prematurely because of the 
war service of a father or other near relative. 

Again, the various religious and social organizations of the 
community have many contacts with the families. To these agen- 
cies the Red Cross has given full information about the work of 
Home Service. This is not done by formal approach through cir- 
cular or advertisement but by personal contact and association and 
by drawing into the Home Service Sections, as members, repre- 
sentatives of these social agencies and religious societies. Home 
Service Sections have estabUshed friendly relationships with the vari- 
ous state and local Councils of Defense, who notify them promptly 
of homes where Home Service is required. Finally, Home Service 
Sections have established contacts with Exemption Boards, and 
have in many instances learned thereby of the needs of families 
of drafted men. 

How Home Service is Given 

Home Service has demonstrated its ability to conserve human 
resources in thousands of homes by helping to maintain there good 
standards of child care, of physical and mental health, of education, 
and of working conditions. In some communities these standards 

13 



178 The Annals of the American Academy 

have been achieved only after long toil. Home Service is helping 
to maintain them. 

Living is more difficult for everyone in war times, and the first 
thing a Home Service visitor comes to understand in trying to 
conserve the welfare of children, is that their mothers are, beyond 
everything, often lonely and discouraged. Whatever will give 
the mothers courage to "carry on" helps the children. From 
many different parts of the country comes the story of women whose 
outlook is suddenly darkened, whose need is for sympathetic under- 
standing of their plight, for the development of new interests and 
cheerful companionship. Some are facing the birth of a first child 
alone; some have displayed symptoms of mental depression that 
require the promptest attention and, in a few cases, hospital care. 
The absence of the man deprives the family of the interest which 
he brings home with him from the world of trade and industry. 
This lack and loss of companionship must, so far as possible, be re- 
placed. Various forms of recreation, including clubs and classes, 
become, therefore, very important for the mother as well as for the 
children. 

The chairman of a Home Service Section reports one instance 
in which discouragement led a mother to write to the department 
of soldiers' aid in her state, asking her husband's release from the 
army; her three boys, she stated, were so unruly that she could do 
nothing with them. A Home Service visitor, asked to report upon 
this request, found the family in no financial difficulty, but the 
mother so worried that she lacked the mental energy to cope with 
three little lads all of whom were full of life and high spirits. The 
visitor's first suggestion was a vacation for the mother and a tem- 
porary housekeeper for her children. But the boys would have 
none of this, protesting that they wanted their own mother and no 
one else. This new attitude upon their part gave no small degree of 
comfort to the discouraged woman. She began to enter into the 
recreational plans for the children, whioh were proposed and carried 
out by the visitor, but seemed to respond most of all to the chance 
to talk over personal affairs at frequent intervals with someone who 
was really interested in them. 

The health of young children is a matter of constant concern 
on the part of the Home Service worker who is urged to consult the 
physician advising the Section about the obvious indications of 



Soldiers' and Sailors' Families 179 

malnutrition, adenoids, and other frequent ailments of infants. 
Speaking generally, any sign of debilitation, such as persistent cold, 
cough, loss of weight and appetite, mouth breathing and pallor 
prompts the visitor to urge the parent that medical advice be 
secured. 

All available resources for the health-care of the school child 
are brought to bear when at all needed. Home Service workers 
make full use of the services of the infant welfare nurse, the school 
nurse, and the tuberculosis nurse, and of any visiting nurse or public 
health nurse in the community. Such nurses are sometimes asked 
to advise about dietaries and food economies as well as concerning 
matters of health. 

A representative of the national Children's Bureau says that 
the chief measure for protecting babies is to insure their care and 
nursing by healthy mothers in their own homes. Helping mothers 
to plan their affairs so as to remain at home most of the time while 
the children are small is a health measure for both mother and child, 
though a woman's temperament and her standard of home care 
before the enlistment of the breadwinners should be taken into con- 
sideration. 

Faithful school attendance is often assured by arranging, when 
necessary, for regular reports from teachers. When the age for 
leaving school approaches — in fact, long before it has krrived — 
Home Service seeks the best vocational guidance obtainable for 
the boy or girl. Its workers discourage entrance into occupations 
in which there is no future, no skill to be acquired, no good chance 
of advancement, or in which the processes menace health. 

Problems of boys and girls in their early teens — in the years of 
adolescence — often require the wisest advice available from teachers, 
club leaders, and from others experienced in child helping. 

Sometimes the mother is unable to manage the family affairs 
as she should. She may even be the victim of a bad habit. Then 
it is important that the allotment of pay and the family allowance 
be expended by someone else who will administer it for her and her 
children's best welfare. Soldiers and sailors have had to appeal 
to Home Service Sections in such situations, the solution requiring 
court intervention in some cases and in others not. 

Another difficult situation is that of the father whose wife has 
died. A widower, drafted into the army, appealed to the Home 



180 The Annals of the American Academy 

Service Section in his city to arrange for proper care for his one 
child. This was done with the help of a child-placing agency, and 
the child's board being paid by the father through the Home Service 
Section. 

The question has been asked whether unmarried women who are 
the mothers of soldiers' children come within the scope of Home 
Service. Such mothers do, and so do their children. The legal 
rights of both mother and child should be known. In handling 
such cases, a denial by the man must be investigated, remembering, 
however, the possibility of blackmail and so being very careful to 
deal fairly with both man and woman on the basis of all the facts 
obtainable, and with the competent advice and service of a good 
lawyer of sympathetic mind who should be a member of each Home 
Service Section. 

Many people become so accustomed to a low health standard 
that they actually regard ill-health as a normal thing. Home 
Service visitors try to accustom families to a higher standard, and 
to attend to dental defects, eye defects, nose and throat defects in 
time, bringing them promptly to the notice of the proper medical 
and dental specialists. 

It is necessary, in particular, to guard against an increase of 
tuberculosis. The experience of foreign countries, especially of 
France, in this war, indicates the possible rapid spread of this 
disease. Accordingly, especial attention is directed (1) to any 
loss of weight in members of the families visited, (2) to a persistent 
cold or cough, (3) to fever or loss of appetite. Suspected cases are 
referred to a doctor or to the local tuberculosis dispensary. " In 
families where we have found a history of tuberculosis in the past," 
writes the secretary of one Home Service Section, "we have had 
examinations made and have been able to give treatment to patients 
who had not known they required a physician's care." 

Here is an extract from the notes of one Home Service visitor. 

We were asked to furnish crutches in this family for the lame boy of thirteen- 
He lives with his father, mother and five brothers and sisters, of whom the oldest 
boy has enlisted. I found all the others in bad physical condition owing to a 
combination of insufficient income, poor management, and lack of knowledge of 
food values, so I took every one of them to a dispensary, where they were examined 
by specialists. Two doctors examined the boy wlio "needed crutches." With 
the consent of his parents and his priest, he was operated upon with satisfactory 
results. I am teaclung the mother how and what to cook. There is an aston- 
ishing physical improvement in every member of the family.^ 



Soldiers' and Sailors' Families 181 

Mention has been made of the importance of keeping children 
in school and assuring regular attendance there, but Home Service 
Sections are doing more than this. Children who had been re- 
moved and put to work to meet a shrinkage in the family income 
are being returned to school promptly, as soon as Home Service is 
called in. One Home Service Section reports a boy, found to be 
working illegally nearly fourteen hours a day, who has been re- 
turned to school. This Section is making special provision to keep 
children between the ages of fourteen and sixteen in classes where 
they will receive a good preparation for earning their living later. 
Another is taking children out of "bhnd alley" occupations and 
providing special aid to give them training for better work. An- 
other reports upon a wayward boy who has been introduced to the 
Boy Scouts and is now doing well in school. Still another made 
it possible for a young man to complete his last year in college by 
paying the necessary tuition after his father entered the national 
army. One member of a Home Service Section is getting a great 
deal of pleasure out of giving free music lessons to three children 
whose father has died. 

Unless we are able to learn by the mistakes of Great Britain in 
the earlier years of her present struggle- — mistakes which she recog- 
nizes now — we shall be confronted with attempts to speed up in- 
dustry at the expense of the health and strength of the workers. 
The strict administration of the laws now on our statute books for 
the protection of workers against long hours and unwholesome 
processes is placed upon the conscience of those engaged in Home 
Service. 

First of all, the Home Service worker is expected to know what 
the national, state, and local provisions are — not only the laws 
regulating working conditions, but the agencies and officials re- 
sponsible for their enforcement. What provisions are there about 
maximum hours? What is a standard working day for men, for 
women, for children of working age? Is one day's rest in seven 
provided for by law? Is night work prohibited for women? For 
children? What hazardous employments are prohibited for either 
or both? Children who work are required to have employment 
certificates in almost all of our states. Have these been issued 
legally? Women need special protection from overwork before 
and after childbirth. Lawyers interested in Home Service are 



182 The Annals of the American Academy 

asked to advise about the laws applicable to these matters. By 
order of the Quartermaster-General of the Army, uniforms for 
soldiers cannot be worked upon in any tenement house or dwelling. 
Home Service workers give valuable help in the enforcement of the 
order by making it known to the families with which they have to 
deal. 

Home Service Sections are systematically avoiding the practice 
of thrusting women into industry who can serve the family better 
at home. Before family allowances made earning outside the home 
less necessary, they were assuming extra financial burdens cheer- 
fully in order to keep mothers with their children and this is im- 
portant to safeguard home life on this side. 

The Red Cross beheves that it owes consideration to the 
agencies in each locality which are carr3dng permanently the 
responsibility for social service. At its annual meeting in Decem- 
ber, 1917, the Red Cross adopted a resolution which in substance 
is as follows: That while the Red Cross needs and must use immense 
sums of money for unusual purposes, it does not wish to receive that 
money at the expense of the permanent social work of this country 
but desires that the support, of the Red Cross shall be in addition 
to that work. The Red Cross believes that the work of the local 
social agencies in each community must continue during the war, 
not only with full vigor, but with increased resources, in order to 
meet needs that are becoming greater; and the Red Cross holds that 
these local agencies must be ready to do their full part in social 
reconstruction when the war is over. It is the purpose of the Red 
Cross that the awakening sense of social responsibility shall be 
utilized by the agencies which are permanent and necessary, and 
that these organizations shall increase in membership and resources 
during the war, as their needs may require. The desh-e of the Red 
Cross, especially in its work of Home Service, is that everywhere 
there be the most cordial cooperation. 

Training of Home Service Workers 

Successful Home Service work depends, indeed, not so much 
upon the extensiveness of the knowledge and experience of those 
relatively few persons who will be actively engaged in it, as upon their 
ability to utilize the knowledge and experience of others. They 
levy a claim upon the expertness of the whole community to which 



Soldiers' and Sailobs' Families 183 

the possessors of special knowledge and skill have been only too 
glad to respond with enthusiasm, once it has been made clear that 
the Red Cross intends to do its fair share and that it makes good 
that intention. 

In order that there may be a larger number of trained and 
competent executives for Home Service Sections, the Depart- 
ment of Civilian Relief has established at twenty-five strategic 
centers, representing every section of the country, Home Service 
Institutes. The Institutes are open to executives and members 
of Home Service Sections, and to other qualified volunteers. The 
courses of the Institutes require the full time of those who attend 
for a period of six weeks. The programs of all the Institutes are 
practically the same. They are prescribed by the Red Cross and 
are given under its auspices. The course includes four hours of 
lectures and discussion each week, required readings, and the bal- 
ance of the time — about twenty-five hours each week — is spent in 
supervised practical field work in the Home Service of the Chapter 
in whose city the Institute is held and in the local societies that do 
similar work. The membership of each Institute is limited to 
twenty-five, in order to assure adequate personal attention in class- 
room discussion and in the field work. A . certificate is granted 
by the Red Cross to those who complete the work with credit and, 
in the field work, show qualities fitting them to assume responsibility 
in Home Service and aptitude for it. Wherever possible, the In- 
stitute is aflaliated with a well-established University, College, or 
Training School for social work. 

For those unable to attend the Institutes, Chapter Courses are 
held in those cities where competent instruction and field work are 
available. These courses conform to a general standard prescribed 
and published by the Red Cross, but which may readily be adapted 
to local conditions and needs. Chapter Courses are always re- 
lated intimately to the work of the local Chapters. Many Chapters 
have conducted such courses and many more are planning to do so. 
The Red Cross strongly endorses the organization of such courses 
and believes that the volunteers connected with Home Service 
Sections will work longer and do more if they are given such train- 
ing. The eager response which has been made to the Chapter 
Courses and to the Institutes proves that people no longer feel that 



184 The Annals of the American Academy 

good intentions are qualifications enough for Home Service. They 
want to learn how to do this work in the best possible way. 

Those who have taken up Home Service have been quick to 
see that it requires a familiarity with new problems and a facility 
in dealing with them which can be acquired only through training. 
To be sure, the Home Service Institute, to say nothing of the Chap- 
ter Course, does not make social workers, but it does make informed 
people in the communities from which the students come. In 
short, the Red Cross, realizing its responsibihty and its opportunity, 
is trying to fit itself to discharge that responsibility by beginning at 
the obvious point of departure — through a campaign of education. 
It is the earnest hope of the Red Cross, as it is the test of its stand- 
ards, that through Home Service in cooperation with other agencies, 
the family of no soldier or sailor shall suffer a lowering of its stand- 
ards nor lack any essential thing within the power of the nation 
to give. Home Service is solicitous about the welfare of the families 
of men in the service because it reaUzes that upon the success 
achieved in this task depends the kind of problems that will con- 
front the nation when the war is over. It is the hope of the Red 
Cross that its Home Service may help to awaken a national spirit 
of social responsibility so that when the war is ended, America shall 
have not a new. social problem, but instead a new and greater social 
force in working out its destinies. 



INDEX 



Adoption, factors in, 113, 120. 
Agencies, social, 89, 125, 127, 144, 149. 
Alcohol and Social Case Work. 

Mary P. Wheeler, 154-8. 
Altruism, basis, 22, 26. 
Army, tests, 62. 

Beggars, professional, 151. 

Blind; case work with the, 28, 35; 
exploitation of, 29. 

Blindness, Offsetting the Handi- 
cap OF. Lucy Wright, 28-35. 

Boston School of Social Work, outhne 
suggested by, 33. 

Brannick, Catherine. Principles of 
Case Work with the Feeble-minded, 
60-70. 

Budgets, family, 83, 87. 

Byinqton, Margaret F. The Nor- 
mal Family, 13-27. 

CaUfornia, mother's pension laws, 84. 

Canada, war conditions, 25, 33. 

Case treatment: basis, 131; forms, 35, 
39, 43, 46, 62, 65, 72, 89, 92, 96, 104, 
113, 117, 121, 126, 130, 133, 142, 155, 
169; individualization, 31, 61, 62, 
101, 109, 139, 155; medical pro- 
fession and, 4, 52; method, 1-5, 31, 
34, 36; results, 118, 123; successful, 
2, 5, 7, 117, 166. 

Case Treatment, The Opportunities 
of Social. Karl de Schweinitz, 1-8. 

Case Work and Social Reform. 
Mary Van Kleeck, 9-12. 

Case worker: duties, 23, 95; qualifica- 
tions, 7, 9, 163. See also Social 
worker. 

Charity, pubUc, new experiment in, 90. 

Children: adoption, 120, 125; case 
work with, 117, 126, 130, 133; death 
rate, 50; defective, 65; delinquent, 
133; earnings, 87; family life, 18, 82, 



120, 129; feeble-minded, 65, 68; 
foster care, 119, 123, 127; health, 
179; illegitimate, care of, 104, 110, 
122; institutional, 126, 128. 

Children's Bureau, purpose of, 50. 

Clergyman, social services, 97. 

Cleveland; Cripple Survey, 38; educa- 
tion of the blind, 29. 

CoLCOKD, Joanna C. Desertion and 
Non-support in Family Case Work, 
91-102. 

Courts: illegitimacy and, 108; juvenile, 
17, 133; deUnquency and, 131; de- 
sertion and, 93. 

Criminology, modern, 115. 

Cripple and His Place in the Com- 
munity, The. Amy M. Hamburger, 
36-44. 

Cripple Survey, Cleveland, 38. 

Cripples, classification, 40, 44. 

Defectives, classification, 65, 73. 

Delaware, mother's pension legisla- 
tion, 79. 

Delinquent Children, Essentials 
OF Case Treatment With. Henry 
W. Thurston, 131-39. 

Dehnquents, case treatment of, 131. 

DeSchwbinitz, Karl. The Oppor- 
tunities of Social Case Treatment, 
1-8. 

Desertion: attitude toward, 91, 93; 
causes, 94; National Bureau of, 97; 
percentage, 101. 

Desertion and Non-support in 
Family Case Work. Joanna C. 
Colcord, 91-102. 

Diagnosis: importance, 4, 46, 65, 155; 
medical, 46, 55; social, 46, 55, 65, 69, 
72, 104, 142. 

Disease: prevention, 53, 55; super- 
vision, 88, 113. 

Divorce, state laws, 16. 



185 



186 



Index 



Domestic relations court, case work 

and, 91. 
Drink, effects, 99, 146. 
Drinkers: classifications, 146, 157; 

medical treatment, 158. 

Education, home, 21. 

EflBciency, in the handicapped, 32, 64. 

Employment, for the handicapped, 30, 

32, 42, 68, 73, 140, 168. 
England: juvenile punishment, 23, 132; 

poor laws, 80, 90; soldiers, 33. 
Environment, effects, 27, 65, 130. 

Families: The Soldiers' and Sail- 
ors'. W. Frank Persons, 171-84. 

Family, The Fatherless. Helen 
Glenn Tyson, 79-90. 

Family, The Immigrant. Eva W. 
White, 160-70. 

Family, The Normal. Margaret F. 
Byington, 13-27. 

Family, as an institution, 15, 168. 

agency, difficulties of, 128. 

life: primitive, 14; problems, 20, 

81, 83, 85, 96, 155, 168, 174; star 
bility, 25; value, 81. 

Farm colonies, for the homeless, 151. 

Fatherless Family, The. Helen 
Glenn Tyson, 79-90. 

Feeble-minded: classification, 63; neg- 
lect, 149; treatment, 60, 69. 

Feeble-minded, Principles op Case 
Work with the. Catherine Bran- 
nick, 60-70. 

Feeble-mindedness: definition, 62; in- 
crease, 60. 

Fernald plan, purpose, 61. 

Foster care, institutions v. families, 126. 

Foster Care op Neglected and 
Dependent Children, The. J. 
Prentice Murphy, 117-30. 

Foster homes: disadvantages, 124; for 
illegitimate children, 122; investiga- 
tion, 129. 

France: Home Service, 171 ; penal code, 
131; tuberculosis, 180. 



Germany, juvenile delinquency, 23. 

Hamburger, Amy M. The Cripple 
and His Place in the Community, 
36,44. 

Handicapped, problems of the, 28, 
36, 41, 68, 107, 

Health: England, 181; problem, 51, 88; 
provision for, 48; standard, 180. 

insurance, advantages, 11. 

movement, public, 56; scope, 10. 

Henry, Edna G. The Sick, 45-59. 

Heredity: effects, 103; illegitimate 
child and, 113, 122. 

Home: education, 21, 30, 67; institu- 
tions and, 18, 126; safeguards, 182; 
stability, 25, 172. 

Service: aims, 171; desertion and, 

102; opportunities, 173; organizar 
tion, 175; work, 82. 
^ workers, training, 182. 

Homes: children in, 122, 124, 125; re- 
construction, 27. 

Homeless, The. Stuart A. Rioe, 140- 
53. 

Hospitals: maternity, 111; need for, 50. 

Illegitimacy: causes, 103; desertion 
and, 96; fatherless families and, 85; 
investigation, 105, 114; significance, 
121. 

Illegitimate Family, The. Amey 
Eaton Watson, 103-16. 

Illinois, mother's pension laws, 84. 

Immigrant Family, The. Eva W. 
White, 160-70. 

Immigrant problems, type^, 165. 

Immigrants: schooling for, 161; second 
generation, 167. 

Industrial reform, social workers and, 
11. 

revolution, effects, 19. 

schools, for children, 126. 

Industry: feeble-minded in, 63; home- 
less, in, 140. 

Inebriates, treatment, 150, 158. 



Index 



187 



Institutions: for the handicapped, 60, 
64, 123, 126, 156; health problems in, 
52. 

Interviews, successful, 72, 155. 

Investigation, method, 4. 

Labor, employment of handicapped, 
36, 41, 63, 149. 

reserve, make-up of, 141. 

Law: on desertion, 92; effect on mar- 
riage, 157; juvenile delinquents and, 
131. 

Marriage: control, 15, 60; forced, 96, 
112; illegitimacy and, 108. 

Massachusetts: foster care, 125; pro- 
vision for the feeble-minded, 61. 

Comnlission for the Blind, meth- 
ods, 30. 

General Hospital, work, 110. 

Medical profession, social work and, 
4,50. 

Mendicancy, evils of, 151. 

Mental Hygiene, Case Work in the 
Field op. Elnora E. Thomson, 
71-8. 

Minnesota Children's Code, provisions, 
104, 110. 

Mothers: earnings, 86; unmarried, 110, 
124, 180. 

Mother's pension legislation, adminis- 
tration, 79, 89. 

Moral code, development, 23. 

Mortality, infant, 50, 110. 

Municipal lodging house, applicants, 
143. 

MuKPHY, J. Prentice. The Foster 
Care of Neglected and Dependent 
Children, 117-30. 

New Jersey, mother's pension legis- 
lation, 79. 

New York: foster care, 120, 125; 
mother's pension legislation, 79; 
inebriates, 150. 

Charity Organization So- 
ciety, desertion cases, 101. 



Non-support in Family Case Work, 
Desertion and. Joanna C. Col- 
cord, 91-102. 

Norway, Castberg Law, 104. 

Nurses: Home Service, 179; social 
workers and, 49, 53, 58. 

Parents, children and, 16, 23, 24, 119. 

Pennsylvania, mother's pension legis- 
lation, 79. 

Persons, W. Frank. The Soldiers' 
and Sailors' Families, 171-84. 

Physician, social service, 46, 52, 97. 

Poor laws, provisions, 79, 80, 90. 

Probation officer: delinquency and, 
137; desertion and, 93; duties, 134. 

Prognosis, medical and social, 46, 55. 

Psychiatrist, psychologist and, 70. 

Psychology, applied, 94, 103, 114, 128. 

Records, importance of case, 12, 46, 78, 

129. 
Red Cross, Home Service, 82, 171-84. 
ReUgion, effect on marriage, 16. 
ReUgious influence: drunkenness and, 

147, 158; in foster homes, 128. 
Rice, Stuart -A. The Homeless, 

140—53. 

Sailors, famiUes, 82. 

Sailors' Families, The Soldiers' 
AND. W. Frank Persons, 171-84. 

Sanitation, community, 143. 

Schools, enlarging scope, 21. 

Secretaries, quahfications, 164. 

Segregation, for the feeble-minded, 61. 

Sex, as social factor, 96, 107, 116. 

Sick, The. Edna G. Henry, 45-59. 

Social Case Treatment, The Op- 
portunities OF. Karl deSchwein- 
itz, 1-8. 

Social Case Work, Alcohol and. 
Mary P. Wheeler, 154-58. 

Social insurance, value, 48, 90. 

problems, classification, 56. 

Social Reform, Case Work and. 
Mary Van Kleeck, 9-12. 



188 



Index 



Social reform, definition, 9. 

work, scope, 27, 47, 56, 144. 

worker: desertion and, 94; duties, 

48, 55; health movement and, 
11; medical knowledge, 48; illegiti- 
mate families and, 115; qualifica- 
tions, 45, 58, 71; as a teacher, 54. 
See also Case worker. 

Soldiers: disabled, 28, 36, 148, 173; 
families, 82, 102; mentality, 62. 

Soldiers' and Sailghs' Families, 
The. W. Frank Persons, 171-84. 

Thomson, Elnora E. Case Work in 
the Field of Mental Hygiene, 71-78. 

Thubston, Henry W. Essentials of 
Case Treatment with Delinquent 
Children, 131-39. 

Tuberculosis: case treatment, 50; pre- 
vention, 180. 

Ttbon, Helen Glenn. The Father- 
less Family, 79-90. 



Unemployment, consequences, 145. 

Van Kleeck, Mary. Case Work and 
Social Reform, 9-12. 

War: general effects, 25, 36, 102, 119, 
148; social problems after, 57, 90. 

Risk Insurance Law, provisions, 

172, 174. 

Watson, Amey Eaton. The Illegiti- 
mate Family, 103-16. 

Wheeler, Mary P. Alcohol and 
Social Case Work, 154-8. 

White, Eva W. The Immigrant 
Family, 160-70. 

Widow, types, 81. 

Workmen's Compensation and Liabil- 
ity Acts, proposed readjustment, 36. 

Wright, Lucy. Offsetting the Handi- 
cap of Blindness, 28-35. 




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■expiandituresltf families of American #orking fblliV It wi,ll be iljelpfiiltO; 
fecoriomists' whO'' desire ' to reach; relia:ble;"(i0riclu8ion,s ,as .tO; the eConjoifli?: 

.statuS-of OUT yrage'Cd-Tfi^fs."^]^. Y. Times. . ■ ,■,"-;,,.;' ; ''''.ii.v^Price. $'1.25) ' 

,,'.';■''; THE '.SUPER RACE' ^y,sdQTT\NEj^RiNG ''''' '."'V'; 

."' Profes'^orNearing's book' differ^ from other Vorksi; on race culture In two 
rather .important particulars: ' It i?; well *ntteni and it recognizes .that ' 
enyironmerit' arid.educatioii are as necessary ,^8. eugenics to that better 
grade of humati stock which' the author, christe'hs the 'Super; Ra<:e-"; 

-^The Public. '•'''', ;,;"'' , '-:;';'.".' ';"■ ,',,,;;', ,' , ,','; '.':. '■:"";. ' (Price 50c> 

,',;,, The M-boiie obtainal)!e at bookstores' or (>f_lhe publisKer ' :., 

B. W. HUEBSCH '/ 22s Fifth Avenue r\ NEW YORK 






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